Obesity and risk of COVID-19: analysis of UK Biobank

[First paragraph] Whilst emerging evidence has suggested that those with cardiometabolic diseases are at higher risk of severe COVID-19 andresulting complications, less is known about the relative importance of related lifestyle factors. Obesity in particular is associated withimpaired pulmonary function, a suppressed immune system and has been identified as a risk factor in previous infectious outbreaks.Obesity also appears to be prevalent in subjects with COVID-19. However, as recently highlighted, there is a lack of informationregarding the nature of association between body mass index (BMI) and COVID-19. In order to inform this area, we investigated the association between obesity and laboratory confirmed COVID-19 within UK Biobank (application number 36371). Our hypothesis was that BMI and waist circumference would be independently associated with COVID19.</p

Body mass index and risk of COVID-19 across ethnic groups: analysis of UK Biobank study

Coronavirus disease-2019 (COVID-19), an infectious disease caused by the SARS-CoV-2 virus, has devastated global economies and put unprecedented strain on clinical services. Emerging evidence has suggested that black and minority ethnic (BME) groups, particularly South Asian (SA) and black African or Caribbean (BAC) populations, are at an increased risk of COVID-19 and resulting complications1. Obesity is also associated with a higher risk of testing positive for, and dying from,COVID-191,2. However, the interaction between ethnicity and obesity on the risk of COVID-19 has not been tested. As ethnicity is known to modify the association between BMI and cardiometabolic health3,4, we hypothesise that BMI also acts to modify the relative risk of COVID-19 across ethnic groups. [Opening paragraph]</div

Wrist-worn accelerometers: recommending ~1.0 mg as the minimum clinically important difference (MCID) in daily average acceleration for inactive adults

Physical activity is increasingly assessed using wrist-worn accelerometry.1 The primary unit of measurement is acceleration which lacks an obvious concrete meaning in the clinical and public health settings. If the scientific community agreed on a minimum clinically important difference (MCID) that would greatly help users interpret accelerometry data in a more meaningful way. Here we present converging evidence to inform estimation of the MCID in physical activity for inactive adults, expressed as average acceleration measured from wrist-worn accelerometers

Obesity, walking pace and risk of severe COVID-19 and mortality: analysis of UK Biobank.

Obesity is an emerging risk factor for coronavirus disease-2019 (COVID-19). Simple measures of physical fitness, such as self-reported walking pace, may also be important risk markers. This analysis includes 412,596 UK Biobank participants with linked COVID-19 data (median age at linkage = 68 years, obese = 24%, median number of comorbidities = 1). As of August 24th 2020, there were 1001 cases of severe (in-hospital) disease and 336 COVID-19 deaths. Compared to normal weight individuals, the adjusted odds ratio (OR) of severe COVID-19 in overweight and obese individuals was 1.26 (1.07, 1.48) and 1.49 (1.25, 1.79), respectively. For COVID-19 mortality, the ORs were 1.19 (0.88, 161) and 1.82 (1.33, 2.49), respectively. Compared to those with a brisk walking pace, the OR of severe COVID-19 for steady/average and slow walkers was 1.13 (0.98, 1.31) and 1.88 (1.53, 2.31), respectively. For COVID-19 mortality, the ORs were 1.44 (1.10, 1.90) and 1.83 (1.26, 2.65), respectively. Slow walkers had the highest risk regardless of obesity status. For example, compared to normal weight brisk walkers, the OR of severe disease and COVID-19 mortality in normal weight slow walkers was 2.42 (1.53, 3.84) and 3.75 (1.61, 8.70), respectively. Self-reported slow walkers appear to be a high-risk group for severe COVID-19 outcomes independent of obesity

Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study.

Background and aims To describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD) Methods and results A total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated. Conclusions South Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.</p

Monitoring sociodemographic inequality in COVID-19 vaccination uptake in England: a national linked data study

Background The UK began an ambitious COVID-19 vaccination programme on 8 December 2020. This study describes variation in vaccination uptake by sociodemographic characteristics between December 2020 and August 2021. Methods Using population-level administrative records linked to the 2011 Census, we estimated monthly first dose vaccination rates by age group and sociodemographic characteristics among adults aged 18 years or over in England. We also present a tool to display the results interactively. Results Our sample included 35 223 466 adults. A lower percentage of males than females were vaccinated in the young and middle age groups (18–59 years) but not in the older age groups. Vaccination rates were highest among individuals of White British and Indian ethnic backgrounds and lowest among Black Africans (aged ≥80 years) and Black Caribbeans (18–79 years). Differences by ethnic group emerged as soon as vaccination roll-out commenced and widened over time. Vaccination rates were also lower among individuals who identified as Muslim, lived in more deprived areas, reported having a disability, did not speak English as their main language, lived in rented housing, belonged to a lower socioeconomic group, and had fewer qualifications. Conclusion We found inequalities in COVID-19 vaccination uptake rates by sex, ethnicity, religion, area deprivation, disability status, English language proficiency, socioeconomic position and educational attainment, but some of these differences varied by age group. Research is urgently needed to understand why these inequalities exist and how they can be addressed.</p

Differences in Accelerometer-Measured Patterns of Physical Activity and Sleep/Rest Between Ethnic Groups and Age: An Analysis of UK Biobank

Background: Physical activity and sleep are important for health; whether device-measured physical activity and sleep differ by ethnicity is unclear. This study aimed to compare physical activity and sleep/rest in white, South Asian (SA), and black adults by age. Methods: Physical activity and sleep/rest quality were assessed using accelerometer data from UK Biobank. Linear regressions, stratified by sex, were used to analyze differences in activity and sleep/rest. An ethnicity × age group interaction term was used to assess whether ethnic differences were consistent across age groups. Results: Data from 95,914 participants, aged 45–79 years, were included. Overall activity was 7% higher in black, and 5% lower in SA individuals compared with white individuals. Minority ethnic groups had poorer sleep/rest quality. Lower physical activity and poorer sleep quality occurred at a later age in black and SA adults (>65 y), than white adults (>55 y). Conclusions: While black adults are more active, and SA adults less active, than white adults, the age-related reduction appears to be delayed in black and SA adults. Sleep/rest quality is poorer in black and SA adults than in white adults. Understanding ethnic differences in physical activity and rest differ may provide insight into chronic conditions with differing prevalence across ethnicities

Ethnic minorities and COVID-19: Examining whether excess risk is mediated through deprivation.

BackgroundPeople from South Asian and black minority ethnic groups are disproportionately affected by the COVID-19 pandemic. It is unknown whether deprivation mediates this excess ethnic risk.MethodsWe used UK Biobank with linked COVID-19 outcomes occurring between 16th March 2020 and 24th August 2020. A four-way decomposition mediation analysis was used to model the extent to which the excess risk of testing positive, severe disease and mortality for COVID-19 in South Asian and black individuals, relative to white individuals, would be eliminated if levels of high material deprivation were reduced within the population.Results15,044 (53.0% women) South Asian and black and 392,786 (55.2% women) white individuals were included. There were 151 (1.0%) positive tests, 91 (0.6%) severe cases and 31 (0.2%) deaths due to COVID-19 in South Asian and black individuals compared to 1,471 (0.4%), 895 (0.2%) and 313 (0.1%), respectively, in white individuals. Compared to white individuals, the relative risk of testing positive for COVID-19, developing severe disease and COVID-19 mortality in South Asian and black individuals were 2.73 (95% CI: 2.26, 3.19), 2.96 (2.31, 3.61) and 4.04 (2.54, 5.55), respectively. A hypothetical intervention moving the 25% most deprived in the population out of deprivation was modelled to eliminate between 40-50% of the excess risk of all COVID-19 outcomes in South Asian and black populations, whereas moving the 50% most deprived out of deprivation would eliminate over 80% of the excess risk of COVID-19 outcomes.ConclusionsThe excess risk of COVID-19 outcomes in South Asian and black communities could be substantially reduced with population level policies targeting material deprivation

Association of timing and balance of physical activity and rest/sleep with risk of COVID-19: A UK Biobank study

Behavioural lifestyle factors are associated with cardiometabolic disease and obesity, which are risk factors for COVID-19. We aimed to investigate whether physical activity, and the timing and balance of physical activity and sleep/rest, were associated with SARS-CoV-2 positivity and COVID-19 severity. Data from 91,248 UK Biobank participants with accelerometer data, complete covariate and linked COVID-19 data to 19th July 2020 were included. The risk of SARS-CoV-2 positivity and COVID-19 severity, in relation to overall physical activity, moderate-to-vigorous physical activity (MVPA), balance between activity and sleep/rest, and variability in timing of sleep/rest, was assessed with adjusted logistic regression. Of 207 individuals with a positive test, 124 were classified as having a severe infection. Overall physical activity and MVPA were not associated with severe COVID-19, while a poor balance between activity and sleep/rest was (OR per standard deviation: 0.71 [95% CI: 0.62, 0.81]). This was related to higher daytime activity being associated with lower risk (OR 0.75 [0.61, 0.93]) but higher movement during sleep/rest with higher risk (OR 1.26 [1.12, 1.42]) of severe infection. Greater variability in timing of sleep/rest was also associated with increased risk (OR 1.21 [1.08, 1.35]). Results for testing positive were broadly consistent. In conclusion, these results highlight the importance of not just physical activity, but also quality sleep/rest and regular sleep/rest patterns, on risk of COVID-19. Our findings indicate the risk of COVID-19 was consistently ∼1.2 times higher per ∼40-minute increase in variability in timing of proxy measures of sleep, indicative of irregular sleeping patterns

Ethnicity and prognosis following a cardiovascular event in people with and without type 2 diabetes: observational analysis in over 5 million subjects in England

To quantify ethnic differences in the risk of all-cause mortality and cardiovascular disease (CVD) events following a first CVD event in people with and without type 2 diabetes.We identified 5,349,271 subjects with a first CVD between 1 January 2002 and 31 May 2020 in the UK; CVD included aortic aneurism, cerebrovascular accident, heart failure, myocardial infarction, peripheral vascular disease, and other cardiovascular diseases. We estimated adjusted hazard ratios (HRs) for type 2 diabetes and ethnicity of three outcomes: fatal and nonfatal second CVD event (different phenotype compared to the first) and all-cause mortality.Relative to White, HRs indicated lower rates in all ethnicities and for all outcomes in both men (from 0.64 to 0.79 for all-cause death; 0.78 to 0.79 for CVD-related death; and 0.85 to 0.98 for a second CVD event) and women (0.69 to 0.77; 0.77 to 0.83; 0.83 to 0.95, respectively). Irrespective of ethnicity and sex, type 2 diabetes increased rates of all outcomes by around a third.Prognosis following a CVD event was consistently worse in subjects with type 2 diabetes while varied across ethnicities, suggesting the implementation of different strategies for the secondary prevention of CVD in different ethnic groups.</p