Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK
Hamer et al.,
Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study..,
Brain, Behavior, and Immunity, doi:10.1016/j.bbi.2020.05.059
UK Biobank retrospective analysis of 387,109 people, showing lower risk of COVID-19 hospitalization with physical activity.
risk of hospitalization, 27.5% lower, RR 0.72, p < 0.001, adjusted per study, inverted to make RR<1 favor high activity levels, model 2, sufficient vs. no activity, multivariable.
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risk of hospitalization, 33.8% lower, RR 0.66, p < 0.001, adjusted per study, inverted to make RR<1 favor high activity levels, model 1, sufficient vs. no activity, multivariable.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Hamer et al., 31 Jul 2020, retrospective, United Kingdom, peer-reviewed, 4 authors.
Abstract: Brain, Behavior, and Immunity 87 (2020) 184–187
Contents lists available at ScienceDirect
Brain, Behavior, and Immunity
journal homepage: www.elsevier.com/locate/ybrbi
Lifestyle risk factors, inflammatory mechanisms, and COVID-19
hospitalization: A community-based cohort study of 387,109 adults in UK
T
Mark Hamera,⁎, Mika Kivimäkib, Catharine R. Galec,d, G. David Battyb
a
Division of Surgery and Interventional Sciences, Faculty Medical Sciences, University College London, London, UK
Department of Epidemiology and Public Health, University College London, UK
c
MRC Lifecourse Epidemiology Unit, University of Southampton, UK
d
Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, UK
b
ARTICLE INFO
ABSTRACT
Keywords:
Physical activity
Smoking
Obesity
Infection
Coronavirus
C-reactive protein
Population cohort
We conducted the first large-scale general population study on lifestyle risk factors (smoking, physical inactivity,
obesity, and excessive alcohol intake) for COVID-19 using prospective cohort data with national registry linkage
to hospitalisation. Participants were 387,109 men and women (56.4 ± 8.8 yr; 55.1% women) residing in
England from UK Biobank study. Physical activity, smoking, and alcohol intake, were assessed by questionnaire
at baseline (2006–2010). Body mass index, from measured height and weight, was used as an indicator of overall
obesity. Outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16-March-2020 to
26-April-2020. There were 760 COVID-19 cases. After adjustment for age, sex and mutually for each lifestyle
factor, physical inactivity (Relative risk, 1.32, 95% confidence interval, 1.10, 1.58), smoking (1.42;1.12, 1.79)
and obesity (2.05 ;1.68, 2.49) but not heavy alcohol consumption (1.12; 0.93, 1.35) were all related to COVID19. We also found a dose-dependent increase in risk of COVID-19 with less favourable lifestyle scores, such that
participants in the most adverse category had 4-fold higher risk (4.41; 2.52–7.71) compared to people with the
most optimal lifestyle. C-reactive protein levels were associated with elevated risk of COVID-19 in a dose-dependent manner, and partly (10–16%) explained associations between adverse lifestyle and COVID-19. Based on
UK risk factor prevalence estimates, unhealthy behaviours in combination accounted for up to 51% of the population attributable fraction of severe COVID-19. Our findings suggest that an unhealthy lifestyle synonymous
with an elevated risk of non-communicable disease is also a risk factor for COVID-19 hospital admission, which
might be partly explained by low grade inflammation. Adopting simple lifestyle changes could lower the risk of
severe infection.
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