Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study

Simon de Lusignan*, Jienchi Dorward, Ana Correa, Nicholas Jones, Oluwafunmi Akinyemi, Gayatri Amirthalingam, Nicholas Andrews, Rachel Byford, Gavin Dabrera, Alex Elliot, Joanna Ellis, Filipa Ferreira, Jamie Lopez Bernal, Cecilia Okusi, Mary Ramsay, Julian Sherlock, Gillian Smith, John Williams, Gary Howsam, Maria ZambonMark Joy, F. D.Richard Hobbs

*Corresponding author for this work

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Abstract

Background: There are few primary care studies of the COVID-19 pandemic. We aimed to identify demographic and clinical risk factors for testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre primary care network. 

Methods: We analysed routinely collected, pseudonymised data for patients in the RCGP Research and Surveillance Centre primary care sentinel network who were tested for SARS-CoV-2 between Jan 28 and April 4, 2020. We used multivariable logistic regression models with multiple imputation to identify risk factors for positive SARS-CoV-2 tests within this surveillance network. 

Findings: We identified 3802 SARS-CoV-2 test results, of which 587 were positive. In multivariable analysis, male sex was independently associated with testing positive for SARS-CoV-2 (296 [18·4%] of 1612 men vs 291 [13·3%] of 2190 women; adjusted odds ratio [OR] 1·55, 95% CI 1·27–1·89). Adults were at increased risk of testing positive for SARS-CoV-2 compared with children, and people aged 40–64 years were at greatest risk in the multivariable model (243 [18·5%] of 1316 adults aged 40–64 years vs 23 [4·6%] of 499 children; adjusted OR 5·36, 95% CI 3·28–8·76). Compared with white people, the adjusted odds of a positive test were greater in black people (388 [15·5%] of 2497 white people vs 36 [62·1%] of 58 black people; adjusted OR 4·75, 95% CI 2·65–8·51). People living in urban areas versus rural areas (476 [26·2%] of 1816 in urban areas vs 111 [5·6%] of 1986 in rural areas; adjusted OR 4·59, 95% CI 3·57–5·90) and in more deprived areas (197 [29·5%] of 668 in most deprived vs 143 [7·7%] of 1855 in least deprived; adjusted OR 2·03, 95% CI 1·51–2·71) were more likely to test positive. People with chronic kidney disease were more likely to test positive in the adjusted analysis (68 [32·9%] of 207 with chronic kidney disease vs 519 [14·4%] of 3595 without; adjusted OR 1·91, 95% CI 1·31–2·78), but there was no significant association with other chronic conditions in that analysis. We found increased odds of a positive test among people who are obese (142 [20·9%] of 680 people with obesity vs 171 [13·2%] of 1296 normal-weight people; adjusted OR 1·41, 95% CI 1·04–1·91). Notably, active smoking was linked with decreased odds of a positive test result (47 [11·4%] of 413 active smokers vs 201 [17·9%] of 1125 non-smokers; adjusted OR 0·49, 95% CI 0·34–0·71). 

Interpretation: A positive SARS-CoV-2 test result in this primary care cohort was associated with similar risk factors as observed for severe outcomes of COVID-19 in hospital settings, except for smoking. We provide evidence of potential sociodemographic factors associated with a positive test, including deprivation, population density, ethnicity, and chronic kidney disease. Funding: Wellcome Trust.

Original languageEnglish
Pages (from-to)1034-1042
Number of pages9
JournalThe Lancet Infectious Diseases
Volume20
Issue number9
Early online date15 May 2020
DOIs
Publication statusE-pub ahead of print - 15 May 2020

Bibliographical note

Funding Information:
Wellcome Trust. We thank the participating practices and patients for providing the data for this cohort. We acknowledge our collaboration with the general practitioner computer system suppliers-EMIS Health, The Phoenix Partnership, and InPractice Systems-Apollo Medical Systems, Public Health England, Wellcome Trust, and our other funders and collaborators. Public Health England provides the core funding for the Royal College of General Practitioners (RCGP) Research and Surveillance Centre; no specific funding was provided for this analysis but the Nuffield Department of Primary Care Health Sciences has supported the rapid expansion of the network. SdL is the Director of the Oxford RCGP Research and Surveillance Centre. RB, JS, FF, and JW are part funded by Public Health England, and CO and AC by a Wellcome Biomedical resources grant (212763/Z/18/Z). JD and NJ are funded by the Wellcome Trust (216421/Z/19/Z). FDRH is part funded by the National Institute for Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research and Care Oxford, the NIHR Oxford Biomedical Research Centre, and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative. FDRH reports personal fees from Novartis and Boehringer Ingelheim and grants from Pfizer. All other authors declare no competing interests.

Open Access: This is an Open Access article under the CC BY 4.0 license.

Publisher Copyright: © 2020 The Author(s). Published by Elsevier Ltd.

Citation: de Lusignan, Simon, et al. "Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study." The Lancet Infectious Diseases 20.9 (2020): 1034-1042.

DOI: https://doi.org/10.1016/S1473-3099(20)30371-6

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