The association between a lifestyle score, socioeconomic status, and COVID-19 outcomes within the UK Biobank cohort

Abstract

Background Infection with SARS-CoV-2 virus (COVID-19) impacts disadvantaged groups most. Lifestyle factors are also associated with adverse COVID-19 outcomes. To inform COVID-19 policy and interventions, we explored effect modification of socioeconomic-status (SES) on associations between lifestyle and COVID-19 outcomes. Methods Using data from UK-Biobank, a large prospective cohort of 502,536 participants aged 37–73 years recruited between 2006 and 2010, we assigned participants a lifestyle score comprising nine factors. Poisson regression models with penalised splines were used to analyse associations between lifestyle score, deprivation (Townsend), and COVID-19 mortality and severe COVID-19. Associations between each exposure and outcome were examined independently before participants were dichotomised by deprivation to examine exposures jointly. Models were adjusted for sociodemographic/health factors. Results Of 343,850 participants (mean age > 60 years) with complete data, 707 (0.21%) died from COVID-19 and 2506 (0.76%) had severe COVID-19. There was evidence of a nonlinear association between lifestyle score and COVID-19 mortality but limited evidence for nonlinearity between lifestyle score and severe COVID-19 and between deprivation and COVID-19 outcomes. Compared with low deprivation, participants in the high deprivation group had higher risk of COVID-19 outcomes across the lifestyle score. There was evidence for an additive interaction between lifestyle score and deprivation. Compared with participants with the healthiest lifestyle score in the low deprivation group, COVID-19 mortality risk ratios (95% CIs) for those with less healthy scores in low versus high deprivation groups were 5.09 (1.39–25.20) and 9.60 (4.70–21.44), respectively. Equivalent figures for severe COVID-19 were 5.17 (2.46–12.01) and 6.02 (4.72–7.71). Alternative SES measures produced similar results. Conclusions Unhealthy lifestyles are associated with higher risk of adverse COVID-19, but risks are highest in the most disadvantaged, suggesting an additive influence between SES and lifestyle. COVID-19 policy and interventions should consider both lifestyle and SES. The greatest public health benefit from lifestyle focussed COVID-19 policy and interventions is likely to be seen when greatest support for healthy living is provided to the most disadvantaged groups.

Prevalence and predictors of outcomes among ESRD patients with COVID-19

“…In Washington D.C., the most recent corresponding numbers are 134,623 and 1,319, respectively [7]. The risk for developing severe symptoms and death from COVID-19 is higher in patients who are socioeconomically disadvantaged, and in those with large burden of comorbidities, which is consistent with the recent literature [8,9]. A recent meta-analysis of 34 studies reported high COVID-19 prevalence and case fatality rates among ESRD patients [10].…”

Changes in HDL cholesterol, particles, and function associate with pediatric COVID-19 severity

“…Recombinant HDL is being explored as a new COVID-19 treatment ( 58 ), but exercise ( 59 ) and a balanced, fiber-rich, plant-centered diet ( 60 ) are proven, if underutilized strategies known to improve HDL function. Retrospective analysis of 2,884 health care workers in six countries severely impacted by the COVID-19 pandemic ( 61 ) and of 343,850 adults followed in the UK Biobank ( 62 ), as well as a prospective smartphone-based COVID symptom study of 592,571 UK and US participants ( 63 ) all associated significantly less symptom severity with healthier lifestyle practices. The findings reported upon here suggest one mechanism, improved HDL function, that may mediate the observed association between therapeutic lifestyle change and strengthened immunity against COVID-19.…”

Epidemiological Profile and Social Welfare Index as Factors Associated with COVID-19 Hospitalization and Severity in Mexico City: A Retrospective Analysis

“…Results of COVID-19 observed in this study can be compared with some studies conducted in different population with similar results when social indexes and variables of socioeconomic status (SES) were considered. For example, Foster et al [ 15 ] reported major risk of severe cases (RR 6.02, 95% CI 4.72–7.71) and higher mortality (RR 9.60, 95% CI 4.70–21.44) in individuals living in deprivation areas and had unhealthy life styles in United Kingdom. Likewise, specific data of SES as poverty level, income, education level, household size and ethnicity has been associated with higher probability of mortality and hospitalization rate in more than 10% to almost 80% for USA reports [ 14 , 16 ]…”

“…In addition, people living in conditions of socioeconomic deprivation, such as crowded populations, are associated with lower healthcare service access, low income, increased number of persons per house, and/or unhealthy lifestyles factors, leading to higher rates of SARS-CoV2 infection and possibly worse COVID-19 outcomes, such as the need of hospitalization or the need for mechanical ventilation, understood as a condition of intensive care unit hospitalization. [ 15 , 16 ]. Other socioeconomic factors, such as low-income jobs or unemployment (i.e., deriving in lower opportunities to purchase protective equipment, such as appropriate facemasks), low educational level (deriving in not understanding or not following health recommendations or the correct use of the protective equipment), poor diet quality or the use of highly crowded public transport are linked to COVID-19.…”