Lifestyle Risk Factors for Cardiovascular Disease in Relation to COVID-19 Hospitalization: A Community-Based Cohort Study of 387,109 Adults in UK

Abstract

Aims: It is important to identify characteristics of people who may be most at risk of COVID-19 to inform policy and intervention. Little is known about the impact of unhealthy lifestyles including smoking, physical inactivity, obesity, and excessive alcohol intake. We conducted the first large-scale general population study on lifestyle risk factors for COVID-19.Methods: Prospective cohort study with national registry linkage to hospitalisation for COVID-19. 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)(2007)(2008)(2009)(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.Results: 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 COVID-19. 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. This gradient was little affected after adjustment for a wide range of covariates. 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.Conclusions and Relevance: 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, accounting for up to half of severe cases. Adopting simple lifestyle changes could lower the risk of severe infection.

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

“…Many studies reported COVID‐19 hospitalizations, but only a few reported the relationship between individuals with obesity and hospitalization. We identified 19 studies that examined the relationship and included them in this analysis 1,28,38,40,44,47–58 . Table S4 presents the results 1,45,47,48,59,60 ; all showed a significantly higher prevalence of individuals with obesity among hospitalized patients than among patients not hospitalized or the general population.…”

Behavioral Change Towards Reduced Intensity Physical Activity Is Disproportionately Prevalent Among Adults With Serious Health Issues or Self-Perception of High Risk During the UK COVID-19 Lockdown

“…Longer term, it is also possible that changes in PA behaviors could serve to increase the size of the population that is vulnerable to severe complications from COVID-19 in subsequent epidemic waves. Furthermore, a recent study showed that physical inactivity was one lifestyle-related risk factor for severe COVID-19 requiring hospital admission (7). In this study we identify whether the UK's lockdown measures have had disproportionate impacts on PA intensity in groups who are, or who perceive themselves to be at risk of worse outcomes of 1 Available online at: https://www.who.int/news-room/detail/30-01-2020statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov).…”

Impact of the COVID-19 pandemic on willingness to adopt healthy dietary habits in China

“…Meanwhile, there are also population cohort data on possible adverse effects of poor lifestyle on serious COVID-19 infections. For example, Mark Hamer et al found a dose-dependent increase in risk of COVID-19 with less favorable lifestyle scores, such that participants in the most adverse category had 4fold higher risk (4.41; 95% CI: 2.52-7.71) compared to people with the most optimal lifestyle 6 . The population attributable fraction of severe COVID-19 for the three unhealthy lifestyle factors in combination was 51.4% (13.3% for smoking, 8.6% for physical inactivity, and 29.5% for overweight and obesity) 6 .…”

“…For example, Mark Hamer et al found a dose-dependent increase in risk of COVID-19 with less favorable lifestyle scores, such that participants in the most adverse category had 4fold higher risk (4.41; 95% CI: 2.52-7.71) compared to people with the most optimal lifestyle 6 . The population attributable fraction of severe COVID-19 for the three unhealthy lifestyle factors in combination was 51.4% (13.3% for smoking, 8.6% for physical inactivity, and 29.5% for overweight and obesity) 6 . Furthermore, peripheral in ammation caused by COVID-19 may have long-term consequences in those that recover, leading to chronic medical conditions such as dementia and neurodegenerative disease, which is involved in neuroin ammatory mechanisms that can be compounded by lifestyle habits, such as consumption of unhealthy diets 7 .…”