Association of pre-pandemic high-density lipoprotein cholesterol with risk of COVID-19 hospitalisation and death: The UK Biobank cohort study

There is growing evidence of, and biological plausibility for, elevated levels of high-density lipoprotein cholesterol (HDL-C) being related to lower rates of respiratory disease. We tested whether pre-pandemic HDL-C within the normal range is associated with subsequent COVID-19 hospitalisations and death. We analysed data on participants from UK Biobank, a prospective cohort study, baseline data for which were collected between 2006 and 2010. Follow-up for COVID-19 was via hospitalisation records (1845 events in 317,306 individuals) and a national mortality registry (458 deaths in 317,833 individuals). After controlling for a series of confounding factors which included health behaviours, inflammatory markers, and socio-economic status, higher levels of HDL-C were related to a lower risk of later hospitalisation. The effect was linear (p-value for trend 0.001), whereby a 0.2 mmol/L increase in HDL-C was associated with a 7% lower risk (odds ratio; 95% confidence interval: 0.93; 0.90, 0.96). Corresponding relationships for mortality were markedly weaker, such that statistical significance at conventional levels were not apparent for both the linear trend (p-value 0.25) and the odds ratio per 0.2 mmol/L increase (0.98; 0.91, 1.05). While our finding for HDL-C and hospitalisations for COVID-19 raise the possibility that favourable modification of this cholesterol fraction via lifestyle changes or drug intervention may impact upon the risk of the disease, it warrants testing in other studies

Ethnic Disparities in Hospitalization for COVID-19: a Community-Based Cohort Study in the UK

Importance: Differentials in COVID-19 incidence, hospitalization and mortality according to ethnicity are being reported but their origin is uncertain. Objective: We aimed to explain any ethnic differentials in COVID-19 hospitalization based on socioeconomic, lifestyle, mental and physical health factors. Design: Prospective cohort study with national registry linkage to hospitalisation for COVID-19. Setting: Community-dwelling. Participants: 340,966 men and women (mean age 56.2 (SD=8.1) years; 54.3% women) residing in England from the UK Biobank study. Exposures: Ethnicity classified as White, Black, Asian, and Others. Main Outcome(s) and Measure(s): Cases of COVID-19 serious enough to warrant a hospital admission in England from 16-March-2020 to 26-April-2020. Results: There were 640 COVID-19 cases (571/324,306 White, 31/4,485 Black, 21/5,732 Asian, 17/5,803 Other). Compared to the White study members and after adjusting for age and sex, Black individuals had over a 4-fold increased risk of being hospitalised (odds ratio; 95% confidence interval: =4.32; 3.00-6.23), and there was a doubling of risk in the Asian group (2.12; 1.37, 3.28) and the Other non-white group (1.84; 1.13, 2.99). After controlling for 15 confounding factors which included neighbourhood deprivation, education, number in household, smoking, markers of body size, inflammation, and glycated haemoglobin, these effect estimates were attenuated by 33% for Blacks, 52% for Asians and 43% for Other, but remained raised for Blacks (2.66; 1.82, 3.91), Asian (1.43; 0.91, 2.26) and other non-white groups (1.41; 0.87, 2.31). Conclusions and Relevance: Our findings show clear ethnic differences in risk of hospitalization for COVID-19 which do not appear to be fully explained by known explanatory factors. If replicated, our results have implications for health policy, including the targeting of prevention advice and vaccination coverage

Pre-pandemic cognitive function and COVID-19 vaccine hesitancy: cohort study

BACKGROUND: Whereas several predictors of COVID-19 vaccine hesitancy have been reported, the role of cognitive function is largely unknown. Accordingly, our objective was to evaluate the association between scores from an array of cognitive function tests and self-reported vaccine hesitancy after the announcement of the successful testing of the first COVID-19 vaccine (Oxford University/AstraZeneca). METHODS: We used individual-level data from a pandemic-focused study ('COVID Survey'), a prospective cohort study nested within United Kingdom Understanding Society ('Main Survey'). In the week immediately following the announcement of successful testing of the first efficacious inoculation (November/December 2020), data on vaccine intentionality were collected in 11,740 individuals (6702 women) aged 16-95 years. Pre-pandemic scores on general cognitive function, ascertained from a battery of six tests, were captured in 2011/12 wave of the Main Survey. Study members self-reported their intention to take up a vaccination in the COVID-19 Survey. RESULTS: Of the study sample, 17.2% (N = 1842) indicated they were hesitant about having the vaccine. After adjustment for age, sex, and ethnicity, study members with a lower baseline cognition score were markedly more likely to be vaccine hesitant (odds ratio per standard deviation lower score in cognition; 95% confidence interval: 1.76; 1.62, 1.90). Adjustment for mental and physical health plus household shielding status had no impact on these results, whereas controlling for educational attainment led to partial attenuation but the probability of hesitancy was still elevated (1.52; 1.37, 1.67). There was a linear association for vaccine hesitancy across the full range of cognition scores (p for trend: p < 0.0001). CONCLUSIONS: Erroneous social media reports might have complicated personal decision-making, leading to people with lower cognitive ability being vaccine-hesitant. With individuals with lower cognition also experiencing higher rates of COVID-19 in studies conducted prior to vaccine distribution, these new findings are suggestive of a potential additional disease burden

When Is Higher Neuroticism Protective Against Death? Findings From UK Biobank

We examined the association between neuroticism and mortality in a sample of 321,456 people from UK Biobank and explored the influence of self-rated health on this relationship. After adjustment for age and sex, a 1- SD increment in neuroticism was associated with a 6% increase in all-cause mortality (hazard ratio = 1.06, 95% confidence interval = [1.03, 1.09]). After adjustment for other covariates, and, in particular, self-rated health, higher neuroticism was associated with an 8% reduction in all-cause mortality (hazard ratio = 0.92, 95% confidence interval = [0.89, 0.95]), as well as with reductions in mortality from cancer, cardiovascular disease, and respiratory disease, but not external causes. Further analyses revealed that higher neuroticism was associated with lower mortality only in those people with fair or poor self-rated health, and that higher scores on a facet of neuroticism related to worry and vulnerability were associated with lower mortality. Research into associations between personality facets and mortality may elucidate mechanisms underlying neuroticism's covert protection against death

Demographic and geographical risk factors for gonorrhoea and chlamydia in greater Western Sydney, 2003-2013

INTRODUCTION: Notification rates of sexually transmitted infections (STIs) have increased in New South Wales as elsewhere in Australia. Understanding trends in chlamydia and gonorrhoea notifications at smaller geographical areas may assist public health efforts to deliver targeted STI interventions.METHODS: Routinely collected disease notification data from 2 local health districts within the greater Western Sydney area were analysed. De-identified notifications of gonorrhoea and chlamydia were extracted for people aged over 15 years during the period 1 January 2003 to 31 December 2013. Sex-specific and age-specific population notification rates for each infection were calculated. Incidence rate ratios were also calculated with age group, sex, year and local government area (LGA) of residence as explanatory variables.RESULTS: Rates of gonorrhoea and chlamydia increased among males and females over the period. Males had a 4-fold increased risk of gonorrhoea (P<0.0001). Compared with the 30-44 years age group, young people aged 15-29 years had a 70% increased risk of gonorrhoea and a 4-fold increased risk of chlamydia (P values < 0.0001). Chlamydia notifications demonstrated smaller and more uniform annual increases across LGAs compared with gonorrhoea notifications, which appeared more highly clustered.CONCLUSION: Analysis of notification rates of chlamydia and gonorrhoea in the greater Western Sydney area suggest that young people aged 15-29 years and residents of particular LGAs are at greater risk of infection. A limitation was the unknown effect of patterns of testing. Nevertheless, these results can support the planning of local sexual health clinical services as well as the design of targeted health promotion interventions

Intelligence quotient in childhood and the risk of illegal drug use in middle-age: the 1958 National Child Development Survey.

Purpose: High childhood IQ test scores have been associated with increased alcohol dependency and use in adult life, but the relationship between childhood IQ and illegal drug use in later life is unclear. Methods: Participants were 6713 members of the 1958 National Child Development Survey whose IQ was assessed at 11 years and had their lifetime illegal drug use measured at 42 years of age. Results: In analyses adjusted for a range of covariates, a 1 SD (15-point) increase in IQ scores was associated with an increased risk of illegal drug use in women: ever using cannabis (odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.16–1.45), cocaine (OR, 1.66; 95% CI, 1.21–2.27), amphetamines (OR, 1.50; 95% CI, 1.22–1.83), amyl nitrate (OR, 1.79; 95% CI, 1.30–2.46) and “magic mushrooms” (OR, 1.52; 95% CI, 1.18–1.98). Associations were of lower magnitude in men. Conclusions: In this cohort, high childhood IQ was related to illegal drug use in adulthood

Physical capability and the advantages and disadvantages of ageing: Perceptions of older age by men and women in two British cohorts

In an increasingly ageing society, its older members are receiving considerable political and policy attention. However, much remains to be learnt about public perceptions of older age, particularly the views and experiences of older individuals themselves. Drawing on qualitative interviews carried out with members of two British cohorts (N = 60) who have reached the ‘third age’, this paper discusses perceptions of age, focusing particularly on how perceived advantages and disadvantages differ by respondents' self-reported physical capability. The interviews were carried out in 2010 as part of the HALCyon (Healthy Ageing across the Life Course) collaborative research programme. Findings suggest there is some difference in the way older people view aspects of ageing by capability and that although advantages are widely perceived, physical decline and associated health concerns were the overwhelming theme across the conversations. The article concludes by making tentative suggestions to inform the positive ageing agenda and its related policies

Validating a widely used measure of frailty: are all sub-components necessary? Evidence from the Whitehall II cohort study

There is growing interest in the measurement of frailty in older age. The most widely used measure (Fried) characterizes this syndrome using five components: exhaustion, physical activity, walking speed, grip strength, and weight loss. These components overlap, raising the possibility of using fewer, and therefore making the device more time- and cost-efficient. The analytic sample was 5,169 individuals (1,419 women) from the British Whitehall II cohort study, aged 55 to 79 years in 2007–2009. Hospitalization data were accessed through English national records (mean follow-up 15.2 months). Age- and sex-adjusted Cox models showed that all components were significantly associated with hospitalization, the hazard ratios (HR) ranging from 1.18 (95 % confidence interval = 0.98, 1.41) for grip strength to 1.60 (1.35, 1.90) for usual walking speed. Some attenuation of these effects was apparent following mutual adjustment for frailty components, but the rank order of the strength of association remained unchanged. We observed a dose–response relationship between the number of frailty components and the risk for hospitalization [1 component—HR = 1.10 (0.96, 1.26); 2—HR = 1.52 (1.26, 1.83); 3–5—HR = 2.41 (1.84, 3.16), P trend <0.0001]. A concordance index used to evaluate the predictive power for hospital admissions of individual components and the full scale was modest in magnitude (range 0.57 to 0.58). Our results support the validity of the multi-component frailty measure, but the predictive performance of the measure is poor

Conditioning on a Collider May or May Not Explain the Relationship Between Lower Neuroticism and Premature Mortality in the Study by Gale et al. (2017): A Reply to Richardson, Davey Smith, and Munafò (2019)

We (Gale et al., 2017) analyzed data on 321,456 UK Biobank participants to address why higher neuroticism is sometimes related to lower mortality (e.g., Korten et al., 1999). We noted that the studies that revealed an inverse relationship between neuroticism and mortality included self-rated health as a predictor, perhaps because it is associated with mortality, even when multiple objective measures of health status are included in models (for reviews, see Benyamini & Idler, 1999; Idler & Benyamini, 1997). We therefore tested whether including self-rated health, which was modestly related to neuroticism, rS = .23 (Gale et al., p. 1348), in a model changed the sign of the neuroticism–mortality relationship. We found that it did so and then set out to test two possible explanations for this phenomenon

Conditioning on a Collider May or May Not Explain the Relationship Between Lower Neuroticism and Premature Mortality in the Study by Gale et al. (2017): A Reply to Richardson, Davey Smith, and Munafò (2019)

We (Gale et al., 2017) analyzed data on 321,456 UK Biobank participants to address why higher neuroticism is sometimes related to lower mortality (e.g., Korten et al., 1999). We noted that the studies that revealed an inverse relationship between neuroticism and mortality included self-rated health as a predictor, perhaps because it is associated with mortality, even when multiple objective measures of health status are included in models (for reviews, see Benyamini & Idler, 1999; Idler & Benyamini, 1997). We therefore tested whether including self-rated health, which was modestly related to neuroticism, rS = .23 (Gale et al., p. 1348), in a model changed the sign of the neuroticism–mortality relationship. We found that it did so and then set out to test two possible explanations for this phenomenon