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    Patterns of Multimorbidity and Risk of Severe SARS-CoV-2 Infection MESHD: an observational study in the U.K.

    Authors: Yogini V Chudasama; Francesco Zaccardi; Clare L Gillies; Cameron Razieh; Thomas Yates; David E Kloecker; Alex V Rowlands; Melanie J Davies; Nazrul Islam; Samuel Seidu; Nita G Forouhi; Kamlesh Khunti; Deverick J. Anderson; Jimmie Mancell; David Ho; Nathan D. Grubaugh; Yonatan H. Grad; Riina Janno; Irja Lutsar; Raissa Prado Rocha; Alex Fiorini de Carvalho; Pedro Augusto Alves; Jose Luiz Proenca Modena; Artur Torres Cordeiro; Daniela Barreto Barbose Trivella; Rafael Elias Marques; Ronir R Luiz; Paolo Pelosi; Jose Roberto Lapa e Silva

    doi:10.1101/2020.10.21.20216721 Date: 2020-10-23 Source: medRxiv

    Background Pre-existing comorbidities have been linked to SARS-CoV-2 infection MESHD but evidence is sparse on the importance and pattern of multimorbidity (2 or more conditions) and severity of infection MESHD indicated by hospitalisation or mortality. We aimed to use a multimorbidity index developed specifically for COVID-19 to investigate the association between multimorbidity and risk of severe SARS-CoV-2 infection MESHD. Methods We used data from the UK Biobank linked to laboratory confirmed test results for SARS-CoV-2 infection MESHD and mortality data from Public Health England between March 16 and July 26, 2020. By reviewing the current literature on COVID-19 we derived a multimorbidity index including: 1) angina MESHD; 2) asthma HP; 3) atrial fibrillation HP atrial fibrillation MESHD; 4) cancer MESHD; 5) chronic kidney disease HP kidney disease MESHD; 6) chronic obstructive pulmonary disease HP obstructive pulmonary disease MESHD; 7) diabetes mellitus HP diabetes mellitus MESHD; 8) heart failure MESHD; 9) hypertension HP hypertension MESHD; 10) myocardial infarction HP myocardial infarction MESHD; 11) peripheral vascular disease MESHD; 12) stroke HP stroke MESHD. Adjusted logistic regression models were used to assess the association between multimorbidity and risk of severe SARS-CoV-2 infection MESHD (hospitalisation or death MESHD). Potential effect modifiers of the association were assessed: age TRANS, sex, ethnicity, deprivation, smoking status, body mass index, air pollution, 25-hydroxyvitamin D, cardiorespiratory fitness MESHD, high sensitivity SERO C-reactive protein. Results Among 360,283 participants, the median age TRANS was 68 [range, 48-85] years, most were White (94.5%), and 1,706 had severe SARS-CoV-2 infection MESHD. The prevalence SERO of multimorbidity was more than double in those with severe SARS-CoV-2 infection MESHD (25%) compared to those without (11%), and clusters of several multimorbidities were more common in those with severe SARS-CoV-2 infection MESHD. The most common clusters with severe SARS-CoV-2 infection MESHD were stroke HP stroke MESHD with hypertension HP hypertension MESHD (79% of those with stroke HP stroke MESHD had hypertension HP hypertension MESHD); diabetes MESHD and hypertension HP hypertension MESHD (72%); and chronic kidney disease HP chronic kidney disease MESHD and hypertension HP hypertension MESHD (68%). Multimorbidity was independently associated with a greater risk of severe SARS-CoV-2 infection MESHD (adjusted odds ratio 1.91 [95% confidence interval 1.70, 2.15] compared to no multimorbidity). The risk remained consistent across potential effect modifiers, except for greater risk among men. Conclusion The risk of severe SARS-CoV-2 infection MESHD is higher in individuals with multimorbidity, indicating the need to target research and resources in people with SARS-CoV-2 infection MESHD and multimorbidity.

    Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19

    Authors: Viktoria Schwarz; Felix Mahfoud; Lucas Lauder; Wolfgang Reith; Stefanie Behnke; Sigrun Smola; Jürgen Rissland; Thorsten Pfuhl; Bruno Scheller; Michael Böhm; Sebastian Ewen

    doi:10.21203/rs.3.rs-30359/v1 Date: 2020-05-19 Source: ResearchSquare

    Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. As concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome MESHD ( ACS MESHD) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS MESHD and ACVE before (calendar weeks 1 to 9, 2020) and after (calendar weeks 10 to 16, 2020) the first coronavirus disease MESHD (COVID-19) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p=0.018; whole year 2019 = 395 patients per week). After the first COVID-19 diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p=0.0012). Admissions due to ACS MESHD decreased by 41% (p=0.0023 for all; Δ -71% (p=0.007) for unstable angina MESHD, Δ -25% (p=0.42) for myocardial infarction HP myocardial infarction MESHD with ST-elevation and Δ -17% (p=0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1 to 9 to 62 patients in calendar weeks 10 to 16. ACVE decreased numerically by 20% (p=0.25 for all; transient ischemic attack HP ischemic MESHD attack: Δ -32% (p=0.18), ischemic stroke HP ischemic stroke MESHD: Δ -23% (p=0.48), intracerebral haemorrhage MESHD: Δ +57% (p=0.4)). There was no significant change in ACVE per week (p=0.7) comparing calendar weeks 1 to 9 (213 patients) and weeks 10 to 16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients ( prevalence SERO 1,54%, thereof one patient with myocardial and two with cerebral ischemia HP cerebral ischemia MESHD) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events MESHD in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

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Human Phenotype
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