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ObjectiveTo estimate the risk of Long COVID by socioeconomic deprivation and to further examine the socioeconomic inequalities in Long COVID by sex and occupational groups. DesignWe analysed data from the COVID-19 Infection Survey conducted by the Office for National Statistics between 26/04/2020 and 31/01/2022. This is the largest and nationally representative survey of COVID-19 in the UK and provides uniquely rich, contemporaneous, and longitudinal data on occupation, health status, COVID-19 exposure, and Long COVID symptoms. SettingCommunity-based longitudinal survey of COVID-19 in the UK. ParticipantsWe included 201,799 participants in our analysis who were aged between 16 and 64 years and had a confirmed SARS-CoV-2 infection. Main outcome measuresWe used multivariable logistic regression models to estimate the risk of Long COVID at least 4 weeks after acute SARS-CoV-2 infection by deciles of index of multiple deprivation (IMD) and adjusted for a range of demographic and spatiotemporal factors. We further examined the modifying effects of socioeconomic deprivation by sex and occupational groups. ResultsA total of 19,315 (9.6%) participants reported having Long COVID symptoms. Compared to the least deprived IMD decile, participants in the most deprived decile had a higher adjusted risk of Long COVID (11.4% vs 8.2%; adjusted OR: 1.45; 95% confidence interval [CI]: 1.33, 1.57). There were particularly significantly higher inequalities (most vs least deprived decile) of Long COVID in healthcare and patient facing roles (aOR: 1.76; 1.27, 2.44), and in the education sector (aOR: 1.62; 1.26, 2.08). The inequality of Long COVID was higher in females (aOR: 1.54; 1.38, 1.71) than males (OR: 1.32; 1.15, 1.51). ConclusionsParticipants living in the most socioeconomically deprived areas had a higher risk of Long COVID. The inequality gap was wider in females and certain public facing occupations (e.g., healthcare and education). These findings will help inform public health policies and interventions in adopting a social justice and health inequality lens.
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ObjectiveTo estimate vaccine effectiveness (VE) for preventing COVID-19 hospital admission in women first infected with SARS-CoV-2 during pregnancy, and assess how this compares to VE among women of reproductive age who were not pregnant when first infected. DesignPopulation-based cohort study using national, linked Census and administrative data. SettingEngland, United Kingdom, from 8th December 2020 to 31st August 2021. Participants815,4777 women aged 18 to 45 years (mean age, 30.4 years) who had documented evidence of a first SARS-CoV-2 infection in NHS Test and Trace data or Hospital Episode Statistics. Main outcome measuresA hospital inpatient episode where COVID-19 was recorded as the primary diagnosis. Cox proportional hazards models, adjusted for calendar time of infection and sociodemographic factors related to vaccine uptake and risk of severe COVID-19, were used to estimate VE as the complement of the hazard ratio for COVID-19 hospital admission. ResultsCompared with unvaccinated pregnant women, the adjusted rate of COVID-19 hospital admission was 76% (95% confidence interval 69% to 82%) lower for single-vaccinated pregnant women and 83% (75% to 88%) lower for double-vaccinated pregnant women. These estimates were similar to those found for non-pregnant women: 79% (76% to 81%) for single-vaccinated and 82% (80% to 83%) for double-vaccinated. Among those vaccinated more than 90 days before infection, being double-vaccinated was associated with a greater reduction in risk than being single-vaccinated. ConclusionsCOVID-19 vaccination is associated with reduced rates of severe illness in pregnant women infected with SARS-CoV-2, and the reduction in risk is similar to that for non-pregnant women. Waning of vaccine effectiveness occurs more quickly after one dose of a vaccine than two doses. What is already known on this topicBeing pregnant is a risk factor for severe illness and mortality following infection with SARS-CoV-2. Existing evidence suggests that COVID-19 vaccines are effective for preventing severe outcomes in pregnant women. However, research directly comparing vaccine effectiveness between pregnant and non-pregnant women of reproductive age at the population level are lacking. What this study addsOur study provides real-world evidence that COVID-19 vaccination reduces the risk of hospital admission by a similar amount for both women infected with SARS-CoV-2 during pregnancy and women who were not pregnant when infected, during the Alpha and Delta dominant periods in England.
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ImportanceObesity and ethnicity are well characterised risk factors for severe COVID-19 outcomes, but the differential effects of obesity on COVID-19 outcomes by race/ethnicity has not been examined robustly in the general population. ObjectiveTo investigate the association between body mass index (BMI) and COVID-19 mortality across different ethnic groups. Design, Setting, and ParticipantsThis is a retrospective cohort study using linked national Census, electronic health records and mortality data for English adults aged 40 years or older who were alive at the start of pandemic (24th January 2020). ExposuresBMI obtained from electronic health records. Self-reported ethnicity (white, black, South Asian, other) was the effect-modifying variable. Main Outcomes and MeasuresCOVID-19 related death identified by ICD-10 codes U07.1 or U07.2 mentioned on the death certificate from 24th January 2020 until December 28th 2020. ResultsThe analysis included white (n = 11,074,708; mean age 61.9 [{+/-}13.4] years; 54% women), black (n = 416,542; 56.4 [{+/-}11.7] years; 57% women), South Asian (621,691; 55.7 [{+/-}12.4] years; 51% women) and other (n = 478,196; 55.3 [{+/-}11.6] years; 55% women) ethnicities with linked BMI data. The association between BMI and COVID-19 mortality was stronger in ethnic minority groups. Compared to a BMI of 22.5 kg/m2 in white ethnicities, the adjusted HR for COVID-19 mortality at a BMI of 30 kg/m2 in white, black, South Asian and other ethnicities was 0.95 (95% CI: 0.87-1.03), 1.72 (1.52-1.94), 2.00 (1.78-2.25) and 1.39 (1.21-1.61), respectively. The estimated risk of COVID-19 mortality at a BMI of 40 kg/m2 in white ethnicities (HR = 1.73) was equivalent to the risk observed at a BMI of 30.1 kg/m2, 27.0 kg/m2, and 32.2 kg/m2 in black, South Asian and other ethnic groups, respectively. ConclusionsThis population-based study using linked Census and electronic health care records demonstrates that the risk of COVID-19 mortality associated with obesity is greater in ethnic minority groups compared to white populations. QuestionDoes the association between BMI and COVID-19 mortality vary by ethnicity? FindingsIn this study of 12.6 million adults, BMI was associated with COVID-19 in all ethnicities, but with stronger associations in ethnic minority populations such that the risk of COVID-19 mortality for a BMI of 40 kg/m2 in white ethnicities was observed at a BMI of 30.1 kg/m2, 27.0 kg/m2, and 32.2 kg/m2 in black, South Asian and other ethnicities, respectively. MeaningBMI is a stronger risk factor for COVID-19 mortality in ethnic minorities. Obesity management is therefore a priority in these populations.
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BackgroundHealth and key workers are at an increased risk of developing severe COVID-19; it is not known, however, if this risk is exacerbated in those with irregular work patterns. We aimed to investigate the risk of severe COVID-19 in health and shift workers. MethodsWe included UK Biobank participants in employment or self-employed at baseline and with linked COVID-19 data to 31st August 2020. Participants were grouped as neither a health worker nor shift worker (reference category), health worker only, shift worker only, or both and associations with severe COVID-19 investigated in logistic regressions. FindingsOf 235,685 participants (81{middle dot}5% neither health nor shift worker, 1{middle dot}4% health worker only, 16{middle dot}9% shift worker only, and 0{middle dot}3% both), there were 580 (0{middle dot}25%) cases of severe COVID-19. The risk of severe COVID-19 was higher in health workers (adjusted odds ratio: 2.32 [95% CI: 1{middle dot}33, 4{middle dot}05]; shift workers (2{middle dot}06 [1{middle dot}72, 2{middle dot}47]); and in health workers who worked shifts (7{middle dot}56 [3{middle dot}86, 14{middle dot}79]). Being both a health worker and a shift worker had a possible greater impact on the risk severe COVID-19 in South Asian and Black and African Caribbean ethnicities compared to White individuals. InterpretationBoth health and shift work were independently associated with over twice the risk of severe COVID-19; the risk was over seven times higher in health workers who work shifts. Vaccinations, therapeutic and preventative options should take into consideration not only health and key worker status but also shift worker status. FundingNational Institute for Health Research, UK Research and Innovation. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSThe risk of developing severe COVID-19 is greater in occupational groups with higher levels of viral exposure, e.g. health and key workers. We searched PubMed and medRxiv up to December 8, 2020 for papers on shift work patterns, health work and incidence of COVID-19 using the keywords "COVID-19", "SARS-CoV-2", "shift work" "health worker". Recent evidence suggests shift workers are also at increased risk of severe COVID-19 but it is not clear if the risk is exacerbated in those who work shifts in healthcare. Added value of this studyThis study uses data from UK Biobank, a prospective cohort of >500,000 adults aged 40-69 years with baseline assessments between March 2006 and July 2010. Participants occupation was categorised according to whether or not they were health workers and/or shift workers at baseline. Results showed that being a health worker, or working shifts, were similarly and independently associated with over twice the population level risk of severe COVID-19 independent of age, sex, ethnicity, deprivation and co-morbidities. The risk was seven times higher in health workers with shift working patterns. The impact of health and shift work tended to be higher in males and in minority ethnic groups, who are already at an increased risk of severe COVID-19. In people over the age of retirement, the risk of developing severe COVID-19 associated with baseline health worker status was no longer apparent, suggesting the risk is likely explained by exposure to the virus. However, the elevated risk associated with baseline shift worker status persisted, albeit attenuated. Implications of all the available evidenceShift workers are at elevated risk of developing severe COVID-19. The persistence of an elevated risk in people who are now over retirement age, but had a shift worker status at baseline, suggests the risk may not be fully explained by increased exposure to the virus. Vaccination, therapeutic and prevention programmes are being prioritised for health care workers. Our data suggests that shift workers should also be prioritised for these preventive measures.
