Cardiovascular-related deaths at the beginning of the COVID-19 outbreak: a prospective analysis based on the UK Biobank

ObjectiveTo assess the impact of the COVID-19 outbreak on cardiovascular disease (CVD) related mortality and hospitalisation.DesignCommunity-based prospective cohort study.SettingThe UK Biobank.Participants421 372 UK Biobank participants who were registered in England and alive as of 1 January 2020.Primary and secondary outcome measuresThe primary outcome of interest was CVD-related death, which was defined as death with CVD as a cause in the death register. We retrieved information on hospitalisations with CVD as the primary diagnosis from the UK Biobank hospital inpatient data. The study period was 1 January 2020 to June 30 2020, and we used the same calendar period of the three preceding years as the reference period. In order to control for seasonal variations and ageing of the study population, standardised mortality/incidence ratios (SMRs/SIRs) with 95% CIs were used to estimate the relative risk of CVD outcomes during the study period, compared with the reference period.ResultsWe observed a distinct increase in CVD-related deaths in March and April 2020, compared with the corresponding months of the three preceding years. The observed number of CVD-related deaths (n=218) was almost double in April, compared with the expected number (n=120) (SMR=1.82, 95% CI 1.58 to 2.07). In addition, we observed a significant decline in CVD-related hospitalisations from March onwards, with the lowest SIR observed in April (0.45, 95% CI 0.41 to 0.49).ConclusionsThere was a distinct increase in the number of CVD-related deaths in the UK Biobank population at the beginning of the COVID-19 outbreak. The shortage of medical resources for hospital care and stress reactions to the pandemic might have partially contributed to the excess CVD-related mortality, underscoring the need of sufficient healthcare resources and improved instructions to the public about seeking healthcare in a timely way.

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Excess cardiovascular deaths in the beginning of COVID-19 outbreak

10.1101/2020.08.29.20184317 ◽

2020 ◽

Author(s):

Junren Wang ◽

Jianwei Zhu ◽

Huazhen Yang ◽

Yao Hu ◽

Yajing Sun ◽

...

Keyword(s):

Negative Influence ◽

Primary Diagnosis ◽

Hospital Inpatient ◽

Reference Period ◽

Uk Biobank ◽

Expected Number ◽

Mortality Incidence ◽

The Uk ◽

In The Beginning ◽

The Impact

Importance The healthcare demand created by the COVID-19 pandemic was far beyond the hospital surge capacity in many countries, resulting in possible negative influence on prognosis of other severe diseases, such as cardiovascular disease (CVD). Objective To assess the impact of the COVID-19 outbreak on CVD-related hospitalizations and mortality. Design Community-based prospective cohort study. Setting the UK Biobank population. Participants 421,717 UK Biobank participants who were registered in England and alive on December 1st 2019. Main outcomes and measures The primary outcome of interest was CVD death, as deaths with CVD as a cause of death according to the death registers. We retrieved information on hospitalizations with CVD as the primary diagnosis based on the UK Biobank hospital inpatient data. The study period was between December 1st 2019 and May 30th 2020, and we used the same calendar period of the three preceding years as the reference period. Standardized mortality/incidence ratios (SMRs/SIRs) with 95% confidence intervals were used to estimate the relative risk of CVD outcomes during the study period, compared with the reference period, to control for seasonal variations and aging of the study population. Results We observed a distinct increase in CVD-related deaths in March and April 2020 as compared to the corresponding months of the three preceding years. The observed number of CVD death (n=217) was almost doubled in April, compared with the expected number (n=120), corresponding to an SMR of 1.81 (95% CI 1.58-2.06). We observed a sharp decline of CVD hospitalization in March (n=841) and April (n=454), compared with the expected number (n=1208 for March and 1026 for April), leading to an SIR of 0.70 (95% CI 0.65-0.74) for March and 0.44 (95% CI 0.40-0.48) for April. There was also a clear increase of death, but a clear decrease of hospitalization, in March and April for all the five major subtypes of CVD. Conclusions We observed a distinct excess in CVD deaths in the beginning of the COVID-19 outbreak in the UK Biobank population. In addition to CVD complications of SARS-CoV-2 infections, the reduced hospital capacity might have contributed to the observed excess CVD deaths.

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Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2021-048772 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048772

Author(s):

Toby O Smith ◽

Pippa Belderson ◽

Jack R Dainty ◽

Linda Birt ◽

Karen Durrant ◽

...

Keyword(s):

Mixed Methods ◽

Qualitative Study ◽

Online Survey ◽

Musculoskeletal Diseases ◽

Community Dwelling ◽

Secondary Outcome ◽

Healthcare Provision ◽

Social Restriction ◽

The Uk ◽

The Impact

ObjectivesTo determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time.DesignMixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study.SettingUK online survey and interviews with community-dwelling individuals in the East of England.ParticipantsPeople in the UK with RMDs were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study.Primary and secondary outcome measuresThe online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens and how they experienced changes in their social networks.Results703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs 6% reported a decrease). This was significantly worse for those aged 18–60 years compared with older participants (p=0.017). The qualitative findings from 26 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home.ConclusionsPeople with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK.

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Modelling the impact of the tier system on SARS-CoV-2 transmission in the UK between the first and second national lockdowns

BMJ Open ◽

10.1136/bmjopen-2021-050346 ◽

2021 ◽

Vol 11 (4) ◽

pp. e050346

Author(s):

Daniel J Laydon ◽

Swapnil Mishra ◽

Wes R Hinsley ◽

Pantelis Samartsidis ◽

Seth Flaxman ◽

...

Keyword(s):

Real Time ◽

Reproduction Number ◽

Secondary Outcome ◽

Bayesian Hierarchical ◽

Time Reproduction ◽

Tier System ◽

The Uk ◽

National Trends ◽

Tier 3 ◽

The Impact

ObjectiveTo measure the effects of the tier system on the COVID-19 pandemic in the UK between the first and second national lockdowns, before the emergence of the B.1.1.7 variant of concern.DesignThis is a modelling study combining estimates of real-time reproduction number Rt (derived from UK case, death and serological survey data) with publicly available data on regional non-pharmaceutical interventions. We fit a Bayesian hierarchical model with latent factors using these quantities to account for broader national trends in addition to subnational effects from tiers.SettingThe UK at lower tier local authority (LTLA) level. 310 LTLAs were included in the analysis.Primary and secondary outcome measuresReduction in real-time reproduction number Rt.ResultsNationally, transmission increased between July and late September, regional differences notwithstanding. Immediately prior to the introduction of the tier system, Rt averaged 1.3 (0.9–1.6) across LTLAs, but declined to an average of 1.1 (0.86–1.42) 2 weeks later. Decline in transmission was not solely attributable to tiers. Tier 1 had negligible effects. Tiers 2 and 3, respectively, reduced transmission by 6% (5%–7%) and 23% (21%–25%). 288 LTLAs (93%) would have begun to suppress their epidemics if every LTLA had gone into tier 3 by the second national lockdown, whereas only 90 (29%) did so in reality.ConclusionsThe relatively small effect sizes found in this analysis demonstrate that interventions at least as stringent as tier 3 are required to suppress transmission, especially considering more transmissible variants, at least until effective vaccination is widespread or much greater population immunity has amassed.

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Abstract T3: Type 2 Myocardial Infarction Predicts Outcome In Hypertensive Crisis Patients: Nationwide Analysis

Hypertension ◽

10.1161/hyp.78.suppl_1.t3 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Ahmed M Maraey ◽

Ahmed Elzanaty ◽

Hadeer R Elsharnoby ◽

Mahmoud Salem ◽

Mahmoud Khalil ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Hypertensive Crisis ◽

Primary Diagnosis ◽

Hypertensive Emergency ◽

Secondary Outcome ◽

Hypertensive Urgency ◽

Emergency Presentation ◽

The Impact

Background: Type 2 Myocardial infarction (T2MI) can occur in hypertensive crisis patients. The impact of T2MI in this population is poorly understood due to limited available data. Objective: To assess the impact of T2MI on patients admitted to the hospital with hypertensive crisis. Methods: We queried National Readmission Database (NRD) of year 2018 for adult patients admitted with a primary diagnosis of hypertensive crisis. Patients were excluded if they had type 1 myocardial infarction (T1MI), septic shock, or bleeding in the index admission. Primary outcome was 90-day readmission due to T1MI. Secondary outcome was in-hospital mortality. Subgroup analysis was done according to urgency and emergency presentation. Multivariate regression was done to account for confounders. Results: A total of 101211 patients were included in our cohort of whom 3644 (3.6%) were diagnosed with T2MI and 24471 (24.2%) were readmitted within 90 days of discharge. Of those, 912 (3.7%) were diagnosed with T1MI on readmission. T2MI was independently associated with increased odds of 90-day readmission with T1MI (Adjusted odds ratio (aOR): 2.67, 95% CI [1.91-3.75], P=0.000). T2MI effect was observed in hypertensive urgency, and in hypertensive emergency. T2MI was associated with increased in-hospital mortality in hypertensive urgency population (aOR: 4.21, 95% [1.58-11.25], P=0.004) but not in hypertensive emergency (table 1). Conclusion: In hypertensive crisis patients, T2MI was associated with increased 90-day readmission with T1MI. Aggressive management of cardiovascular risk factors and risk stratification should be considered at the time of diagnosis.

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P136 Management of patients with Inflammatory Bowel Disease and their outcome during the first wave of Covid-19 pandemics

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.263 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S223-S224

Author(s):

A Viola ◽

F Giambò ◽

M F Chiappetta ◽

G Costantino ◽

S Pallio ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Secondary Outcome ◽

Reference Period ◽

Disease Flare ◽

Face To Face ◽

Risk Of Disease ◽

Inflammatory Bowel ◽

Group 2 ◽

The Impact

Abstract Background The restrictions adopted in Italy during the phase I COVID-19 pandemics with a nationwide lockdown period, represented a challenge in the management of Patients with Inflammatory Bowel Disease (IBD) patients. The aim of the present study was to assess if, and how, a limited course of telemedicine did influence the clinical outcome in patients with Crohn’s disease (CD) and Ulcerative Colitis (UC). Methods IBD patients followed before March 8th, 2020 were included and divided into 3 groups (Fig.1): group 1, patients on endovenous biologics (EV); group 2, patients on biologics administered subcutaneously (SC); and group 3, patients on conventional treatments (CT) at the start of lockdown. The primary outcome was to assess the occurrence of disease flare in the three groups since only the EV group received face-to-face visits during lockdown. As secondary outcome we assessed the number of control endoscopies performed and the start of new biologic therapies, compared with a reference period in 2019. Results A total of 689 patients (CD: 369, UC 320) were included in the study (247 IV, 217 SC and 225 CT, respectively). Telemedicine was more frequently adopted in SC and CS, (p<0.001) both. Treatment delays or transitory stops were more frequent in EV (p<0.001), whereas there was a significantly greater need to change therapy (p= 0.038) and need for steroids (p = 0.008) in the SC group compared with EV (Tab.1). Concerning endoscopies, compared with the reference period in 2019 only 25% of scheduled endoscopies were performed. The only risk factor for disease flare during or shortly after lockdown was belonging to the patient groups subjected to telemedicine (SC and CT groups) (p < 0.001). Conclusion Patients followed with a face-to-face approach instead of telemedicine, had a lower risk of disease flare during lockdown period. The impact of the important reduction of endoscopic assessments still needs to be assessed.

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Associations of ophthalmic and systemic conditions with incident dementia in the UK Biobank

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319508 ◽

2021 ◽

pp. bjophthalmol-2021-319508

Author(s):

Xianwen Shang ◽

Zhuoting Zhu ◽

Yu Huang ◽

Xueli Zhang ◽

Wei Wang ◽

...

Keyword(s):

Heart Disease ◽

Age Related Macular Degeneration ◽

Hospital Inpatient ◽

Uk Biobank ◽

Age Related ◽

Incident Dementia ◽

Increased Risk ◽

The Uk ◽

Systemic Condition

AimsTo examine independent and interactive associations of ophthalmic and systemic conditions with incident dementia.MethodsOur analysis included 12 364 adults aged 55–73 years from the UK Biobank cohort. Participants were assessed between 2006 and 2010 at baseline and were followed up until the early of 2021. Incident dementia was ascertained using hospital inpatient, death records and self-reported data.ResultsOver 1 263 513 person-years of follow-up, 2304 cases of incident dementia were documented. The multivariable-adjusted HRs (95% CI) for dementia associated with age-related macular degeneration (AMD), cataract, diabetes-related eye disease (DRED) and glaucoma at baseline were 1.26 (1.05 to 1.52), 1.11 (1.00 to 1.24), 1.61 (1.30 to 2.00) and (1.07 (0.92 to 1.25), respectively. Diabetes, heart disease, stroke and depression at baseline were all associated with an increased risk of dementia. Of the combination of AMD and a systemic condition, AMD-diabetes was associated with the highest risk for incident dementia (HR (95% CI): 2.73 (1.79 to 4.17)). Individuals with cataract and a systemic condition were 1.19–2.29 times more likely to develop dementia compared with those without cataract and systemic conditions. The corresponding number for DRED and a systemic condition was 1.50–3.24. Diabetes, hypertension, heart disease, depression and stroke newly identified during follow-up mediated the association between cataract and incident dementia as well as the association between DRED and incident dementia.ConclusionsAMD, cataract and DRED but not glaucoma are associated with an increased risk of dementia. Individuals with both ophthalmic and systemic conditions are at higher risk of dementia compared with those with an ophthalmic or systemic condition only.

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Association of Antioxidants Use with All-Cause and Cause-Specific Mortality: A Prospective Study of the UK Biobank

Antioxidants ◽

10.3390/antiox9121287 ◽

2020 ◽

Vol 9 (12) ◽

pp. 1287

Author(s):

Inken Behrendt ◽

Gerrit Eichner ◽

Mathias Fasshauer

Keyword(s):

Respiratory Disease ◽

Mortality Risk ◽

Cancer Mortality ◽

Primary Objective ◽

Inverse Association ◽

Uk Biobank ◽

Cancer Subtypes ◽

Specific Mortality ◽

The Uk ◽

The Impact

Prospective studies and randomized controlled trials elucidating the impact of antioxidants supplementation on mortality risk are inconclusive. The present analysis determined association between regular antioxidants use and all-cause (primary objective), as well as cause-specific, mortality in 345,626 participants of the UK Biobank cohort using Cox proportional hazard models. All models were adjusted for confounders and multiple testing. Antioxidants users were defined as participants who indicated to regularly use at least one of the following: multivitamins, vitamin C, vitamin E, selenium, and zinc. Median age of antioxidants users (n = 101,159) and non-users (n = 244,467) at baseline was 57 years. During 3.9 million person-years and a median follow-up of 11.5 years, 19,491 deaths occurred. Antioxidants use was not significantly associated with all-cause, cancer, and non-cancer mortality including several cancer and non-cancer subtypes. Interestingly, mortality risk from respiratory disease was significantly 21% lower among antioxidants users as compared to non-users (hazard ratio: 0.79; 95% confidence interval: 0.67, 0.92). In conclusion, the present study findings do not support recommendations for antioxidants supplementation to prevent all-cause, cancer, or non-cancer mortality on a population level. The significant inverse association between antioxidants use and respiratory disease mortality needs further study.

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The impact of cardiovascular risk factors on cardiac structure and function: Insights from the UK Biobank imaging enhancement study

PLoS ONE ◽

10.1371/journal.pone.0185114 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0185114 ◽

Cited By ~ 24

Author(s):

Steffen E. Petersen ◽

Mihir M. Sanghvi ◽

Nay Aung ◽

Jackie A. Cooper ◽

José Miguel Paiva ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Structure And Function ◽

Cardiac Structure ◽

Uk Biobank ◽

Cardiac Structure And Function ◽

The Uk ◽

And Function ◽

The Impact

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Preexisting Comorbidities Predicting COVID-19 and Mortality in the UK Biobank Community Cohort

Innovation in Aging ◽

10.1093/geroni/igab046.1329 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 344-345

Author(s):

Jane Masoli ◽

Joao Delgado ◽

Luke Pilling ◽

Chia-Ling Kuo ◽

George Kuchel ◽

...

Keyword(s):

Fragility Fractures ◽

Uk Biobank ◽

Community Based ◽

Men And Women ◽

History Of ◽

Independent Risk Factors ◽

The Uk ◽

Older Men And Women ◽

Hospital Inpatients ◽

Related Mortality

Abstract Hospitalized COVID-19 patients tend to be older and frequently have hypertension, diabetes or CHD, but whether these co-morbidities are more common than in the general older population is unclear. We estimated associations between pre-existing diagnoses and hospitalized COVID-19 alone or with mortality (during the first COVID-19 outbreak, tests performed between March 16 and April 26, 2020). In 269,070 UK Biobank participants aged 65+, 507 (0.2%) became COVID-19 hospital inpatients, of which 141 (27.8%) died. Common preexisting co-morbidities in hospitalized inpatients were hypertension (59.6%), history of falls/fragility fractures (29.4%), CHD (21.5%), T2 diabetes (19. 9%) and asthma (17.6%). However, in adjusted models, pre-existing diagnoses of dementia, T2 diabetes, COPD, pneumonia, depression, atrial fibrillation and hypertension emerged as independent risk factors for COVID-19 hospitalization, the first five remaining statistically significant for related mortality. There are specific high risk pre-existing co-morbidities for COVID-19 hospitalization and deaths in community based older men and women.

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Metabolic syndrome increases COVID-19-related mortality in the UK Biobank sample

10.1101/2020.10.02.20205716 ◽

2020 ◽

Author(s):

Filip Morys ◽

Alain Dagher

Keyword(s):

Metabolic Syndrome ◽

Waist Circumference ◽

Serum Glucose ◽

Uk Biobank ◽

Glucose Levels ◽

Increased Risk ◽

Confounding Variables ◽

Specific Factors ◽

The Uk ◽

Related Mortality

AbstractPrevious studies link obesity and individual components of metabolic syndrome to increased hospitalisations and death rates of patients with COVID-19. Here, in two overlapping samples of over 1,000 individuals from the UK Biobank we investigate whether metabolic syndrome, and its constituent components, increased waist circumference, dyslipidaemia, hypertension, diabetes, and systemic inflammation, are related to increased COVID-19 infection and mortality rates. Using logistic regression and controlling for confounding variables such as socioeconomic status, age, sex or ethnicity, we find that individuals with pre-existing metabolic syndrome (measured on average eleven years prior to 2020) have an increased risk for COVID-19-related death (odds ratio 1.67). We also find that specific factors contributing to increased mortality are serum glucose levels, systolic blood pressure and waist circumference.

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