Influence of prior comorbidities and chronic medications use on the risk of COVID-19 in adults: a population-based cohort study in Tarragona, Spain
Angel Vila-Córcoles, Olga Ochoa-Gondar, Dr Eva M Satué-Gracia, Cristina Torrente-Fraga, Frederic Gomez-Bertomeu, Angel Vila-Rovira, Immaculada Hospital-Guardiola, Cinta De Diego-Cabanes, Ferran Bejarano-Romero, Josep Basora-Gallisà
BMJ Open, doi:10.1136/bmjopen-2020-041577
Objective To investigate possible relationships between pre-existing medical conditions (including common comorbidities and chronic medications) and risk for suffering COVID-19 disease in middle-aged and older adults. Design Population-based retrospective cohort study. Setting Twelve primary care centres (PCCs) in Tarragona (Spain). Participants 79 083 people (77 676 community-dwelling and 1407 nursing-home residents), who were all individuals aged >50 years affiliated to the 12 participating PCCs. Outcomes Baseline cohort characteristics (age, sex, vaccinations, comorbidities and chronic medications) were established at study start (1st. March 2020) and primary outcome was time to COVID-19 confirmed by PCR among cohort members throughout the epidemic period (from 1st. March 2020 to 23rd. May 2020). Risk for suffering COVID-19 was evaluated by Cox regression, estimating multivariable HRs adjusted for age, sex, comorbidities and medications use. Results During the study period, 2324 cohort members were PCR-tested, with 1944 negative and 380 positive results, which means an incidence of 480.5 PCRconfirmed COVID-19 cases per 100 000 persons-period. Assessing the total study cohort, only age (HR 1.02; 95% CI 1.01 to 1.03; p=0.002), nursing-home residence (HR 21.83; 95% CI 16.66 to 28.61; p<0.001) and receiving diuretics (HR 1.35; 95% CI 1.04 to 1.76; p=0.026) appeared independently associated with increased risk. Smoking (HR 0.62; 95% CI 0.41 to 0.93; p=0.022), ACE inhibitors (HR 0.68; 95% CI 0.47 to 0.99; p=0.046) and antihistamine (HR 0.47; 95% CI 0.22 to 1.01; p=0.052) were associated with a lower risk. Among communitydwelling individuals, cancer (HR 1.52; 95% CI 1.03 to 2.24; p=0.035), chronic respiratory disease (HR 1.82; 95% CI 1.08 to 3.07; p=0.025) and cardiac disease (HR 1.53; 95% CI 1.06 to 2.19; p=0.021) emerged to be also associated with an increased risk. Receiving ACE inhibitors (HR 0.66; 95% CI 0.44 to 0.99; p=0.046) and influenza vaccination (HR 0.63; 95% CI 0.44 to 0.91; p=0.012) was associated with decreased risk. Conclusion Age, nursing-home residence and multiple comorbidities appear predisposing for COVID-19. Conversely, receiving ACE inhibitors, antihistamine and influenza vaccination could be protective, which should be closely investigated in further studies specifically focused on these concerns. ► This is a population-based cohort study involving 79 083 adults aged ≥50 years in Tarragona (Southern Catalonia, Spain). ► Cohort members were retrospectively followed up across the first wave of COVID-19 epidemic period from 1st. March 2020 to 23rd. May 2020. ► Relationships between PCR-confirmed COVID-19 incidence and chronic comorbidities and chronic medications use were assessed by multivariable Cox regression models. ► Despite the large size of study cohort, the number of events was relatively low, which limits statistical power (especially in subgroup analyses). ► PCR testing was not routinely performed (prioritised for..
Open access Competing interests None declared. Patient consent for publication Not required.
Ethics approval The study was approved by the ethical committee of the Institution (Ethics Committee IDIAP Jordi Gol, Barcelona, file 20/065-PCV) and was conducted according to the Helsinki Declaration and Spanish legislation on biomedical studies, data protection and respect for human rights. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available upon reasonable request. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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'abstract': '<jats:sec><jats:title>Objective</jats:title><jats:p>To investigate possible relationships '
'between pre-existing medical conditions (including common comorbidities and chronic '
'medications) and risk for suffering COVID-19 disease in middle-aged and older '
'adults.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Population-based '
'retrospective cohort '
'study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Twelve primary '
'care centres (PCCs) in Tarragona '
'(Spain).</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>79\u2009'
'083 people (77\u2009676 community-dwelling and 1407 nursing-home residents), who were all '
'individuals aged >50 years affiliated to the 12 participating '
'PCCs.</jats:p></jats:sec><jats:sec><jats:title>Outcomes</jats:title><jats:p>Baseline cohort '
'characteristics (age, sex, vaccinations, comorbidities and chronic medications) were '
'established at study start (1st. March 2020) and primary outcome was time to COVID-19 '
'confirmed by PCR among cohort members throughout the epidemic period (from 1st. March 2020 to '
'23rd. May 2020). Risk for suffering COVID-19 was evaluated by Cox regression, estimating '
'multivariable HRs adjusted for age, sex, comorbidities and medications '
'use.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>During the study '
'period, 2324 cohort members were PCR-tested, with 1944 negative and 380 positive results, '
'which means an incidence of 480.5 PCR-confirmed COVID-19 cases per 100\u2009000 '
'persons-period. Assessing the total study cohort, only age (HR 1.02; 95%\u2009CI 1.01 to '
'1.03; p=0.002), nursing-home residence (HR 21.83; 95%\u2009CI 16.66 to 28.61; p<0.001) and '
'receiving diuretics (HR 1.35; 95%\u2009CI 1.04 to 1.76; p=0.026) appeared independently '
'associated with increased risk. Smoking (HR 0.62; 95%\u2009CI 0.41 to 0.93; p=0.022), ACE '
'inhibitors (HR 0.68; 95%\u2009CI 0.47 to 0.99; p=0.046) and antihistamine (HR 0.47; 95%\u2009'
'CI 0.22 to 1.01; p=0.052) were associated with a lower risk. Among community-dwelling '
'individuals, cancer (HR 1.52; 95%\u2009CI 1.03 to 2.24; p=0.035), chronic respiratory disease '
'(HR 1.82; 95%\u2009CI 1.08 to 3.07; p=0.025) and cardiac disease (HR 1.53; 95%\u2009CI 1.06 '
'to 2.19; p=0.021) emerged to be also associated with an increased risk. Receiving ACE '
'inhibitors (HR 0.66; 95%\u2009CI 0.44 to 0.99; p=0.046) and influenza vaccination (HR 0.63; '
'95%\u2009CI 0.44 to 0.91; p=0.012) was associated with decreased '
'risk.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Age, '
'nursing-home residence and multiple comorbidities appear predisposing for COVID-19. '
'Conversely, receiving ACE inhibitors, antihistamine and influenza vaccination could be '
'protective, which should be closely investigated in further studies specifically focused on '
'these concerns.</jats:p></jats:sec>',
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