Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK

Brain Behav Immun. 2020 Jul;87:184-187. doi: 10.1016/j.bbi.2020.05.059. Epub 2020 May 23.

Abstract

We conducted the first large-scale general population study on lifestyle risk factors (smoking, physical inactivity, obesity, and excessive alcohol intake) for COVID-19 using prospective cohort data with national registry linkage to hospitalisation. 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 (2006-2010). 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. 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. C-reactive protein levels were associated with elevated risk of COVID-19 in a dose-dependent manner, and partly (10-16%) explained associations between adverse lifestyle and COVID-19. 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. 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, which might be partly explained by low grade inflammation. Adopting simple lifestyle changes could lower the risk of severe infection.

Keywords: C-reactive protein; Coronavirus; Infection; Obesity; Physical activity; Population cohort; Smoking.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking / adverse effects
  • Betacoronavirus / pathogenicity
  • Body Mass Index
  • C-Reactive Protein / analysis
  • COVID-19
  • Cohort Studies
  • Coronavirus Infections / epidemiology*
  • Exercise / psychology
  • Female
  • Hospitalization
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Obesity / psychology
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Prospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Smoking / epidemiology
  • Surveys and Questionnaires
  • United Kingdom / epidemiology

Substances

  • C-Reactive Protein