Non-communicable disease, sociodemographic factors, and risk of death from infection: a UK Biobank observational cohort study.
Non-communicable disease, sociodemographic factors, and risk of death from infection: a UK Biobank observational cohort study.
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DOI：
10.1016/s1473-3099(20)30978-6
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发表时间：
2021-08
期刊：
影响因子：
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通讯作者：
Cubbon RM
中科院分区：
文献类型：
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作者：
Drozd M;Pujades-Rodriguez M;Lillie PJ;Straw S;Morgan AW;Kearney MT;Witte KK;Cubbon RM
非传染性疾病已被强调为COVID-19死亡率的重要危险因素。然而，关于非传染性疾病患者中传染病的更广泛背景的数据不足。我们的目的是调查在COVID-19大流行之前（截至2019年12月31日），非传染性疾病与任何感染导致的死亡风险之间的关系。在这项观察性研究中，我们使用了来自英国生物银行观察性队列研究的数据来探索与感染死亡相关的因素。如果合并症、体重指数、吸烟状况、种族和社会经济剥夺等数据缺失，以及随访失败或撤回同意，我们将受试者排除在外。截至2019年12月31日，死亡人数被审查。我们使用泊松回归模型，包括英国生物库招募时出现的非传染性疾病（肥胖[用体重指数定义]和自我报告的高血压、慢性心脏病、慢性呼吸系统疾病、糖尿病、癌症、慢性肝病、慢性肾病、既往中风或短暂性缺血发作、其他神经系统疾病、精神障碍、慢性炎症和自身免疫性风湿病）、年龄、性别、种族、吸烟状况、以及社会经济剥夺。构建了单独的模型，用流行非传染性疾病的总数代替单个非传染性疾病，以定义与多发病的关联。所有分析均以非感染相关死亡作为替代结果测量，以建立感染死亡和非感染死亡的差异关联。关联以发病率比（IRR）和95% ci报告。在英国生物银行队列的502505名参与者中排除9210名（1.8%）后，我们的研究样本包括493 295名个体。在5 273 731人年的随访期间（每名参与者平均10.9年[IQR 10.1 - 11.6]），发生了27 729例死亡，其中1385例（5%）与感染有关。高龄、男性、吸烟、社会经济剥夺和所有研究的非传染性疾病与感染死亡率和非感染死亡率均独立相关。与白种人相比，黑人、亚洲人和少数民族人群感染死亡风险降低（IRR 0.64, 95% CI 0.46 - 0.87）和非感染死亡风险降低（0.80,0.75 - 0.86）。年龄增长（65岁vs 45岁：7.59,95%可信区间5.92 - 9.73，感染死亡vs 5.21，非感染死亡：4.97 - 5.48）、当前吸烟（vs从不吸烟：3.69,3.19 - 4.26,vs 2.52, 2.44 - 2.61）、社会经济剥夺（最贫困五分位数vs最贫困五分位数：2.13,1.78 - 2.56,vs 1.38, 1.33 - 1·43）、3级肥胖(vs非肥胖：2·21、1·74-2·82，对1·55、1·44-1·66)、高血压（1·36、1·22-1·53，对1·15、1·12-1·18）、呼吸系统疾病（2·21、1·96-2·50，对1·28、1·24-1·32）、慢性肾病（5·04、4·28 - 7·31，对2·50、2·20-2·84）、精神疾病（1·56、1·30-1·86，对1·23、1·18 - 1·29）、慢性炎症和自身免疫性风湿病（2·45、1·99-3·02，对1·41、1·32 - 1·51）。与非感染死亡风险（5.26、4.84 - 4.72）相比，多重发病的累积与感染死亡风险（5种或5种以上合并症vs无合并症：9.53、6.97 - 13.03）的相关性更强。几种非传染性疾病与感染死亡风险增加有关，这表明报告的一些与COVID-19死亡率的关联可能是非特异性的。与其他死亡原因相比，只有一小部分非传染性疾病，加上多病累积、年龄增长、吸烟和社会经济剥夺，与感染死亡的IRR更高相关。需要进一步的研究来确定为什么这些风险因素与感染死亡有更强的联系，以便针对高风险群体采取更有效的预防战略。英国心脏基金会。
Non-communicable diseases (NCDs) have been highlighted as important risk factors for COVID-19 mortality. However, insufficient data exist on the wider context of infectious diseases in people with NCDs. We aimed to investigate the association between NCDs and the risk of death from any infection before the COVID-19 pandemic (up to Dec 31, 2019). For this observational study, we used data from the UK Biobank observational cohort study to explore factors associated with infection death. We excluded participants if data were missing for comorbidities, body-mass index, smoking status, ethnicity, and socioeconomic deprivation, and if they were lost to follow-up or withdrew consent. Deaths were censored up to Dec 31, 2019. We used Poisson regression models including NCDs present at recruitment to the UK Biobank (obesity [defined by use of body-mass index] and self-reported hypertension, chronic heart disease, chronic respiratory disease, diabetes, cancer, chronic liver disease, chronic kidney disease, previous stroke or transient ischaemic attack, other neurological disease, psychiatric disorder, and chronic inflammatory and autoimmune rheumatological disease), age, sex, ethnicity, smoking status, and socioeconomic deprivation. Separate models were constructed with individual NCDs replaced by the total number of prevalent NCDs to define associations with multimorbidity. All analyses were repeated with non-infection-related death as an alternate outcome measure to establish differential associations of infection death and non-infection death. Associations are reported as incidence rate ratios (IRR) accompanied by 95% CIs. After exclusion of 9210 (1·8%) of the 502 505 participants in the UK Biobank cohort, our study sample comprised 493 295 individuals. During 5 273 731 person-years of follow-up (median 10·9 years [IQR 10·1–11·6] per participant), 27 729 deaths occurred, of which 1385 (5%) were related to infection. Advancing age, male sex, smoking, socioeconomic deprivation, and all studied NCDs were independently associated with the rate of both infection death and non-infection death. Compared with White ethnicity, a pooled Black, Asian, and minority ethnicity group was associated with a reduced risk of infection death (IRR 0·64, 95% CI 0·46–0·87) and non-infection death (0·80, 0·75–0·86). Stronger associations with infection death than with non-infection death were observed for advancing age (age 65 years vs 45 years: 7·59, 95% CI 5·92–9·73, for infection death vs 5·21, 4·97–5·48, for non-infection death), current smoking (vs never smoking: 3·69, 3·19–4·26, vs 2·52, 2·44–2·61), socioeconomic deprivation (most vs least deprived quintile: 2·13, 1·78–2·56, vs 1·38, 1·33–1·43), class 3 obesity (vs non-obese: 2·21, 1·74–2·82, vs 1·55, 1·44–1·66), hypertension (1·36, 1·22–1·53, vs 1·15, 1·12–1·18), respiratory disease (2·21, 1·96–2·50, vs 1·28, 1·24–1·32), chronic kidney disease (5·04, 4·28–7·31, vs 2·50, 2·20–2·84), psychiatric disease (1·56, 1·30–1·86, vs 1·23, 1·18–1·29), and chronic inflammatory and autoimmune rheumatological disease (2·45, 1·99–3·02, vs 1·41, 1·32–1·51). Accrual of multimorbidity was also more strongly associated with risk of infection death (five or more comorbidities vs none: 9·53, 6·97–13·03) than of non-infection death (5·26, 4·84–5·72). Several NCDs are associated with an increased risk of infection death, suggesting that some of the reported associations with COVID-19 mortality might be non-specific. Only a subset of NCDs, together with the accrual of multimorbidity, advancing age, smoking, and socioeconomic deprivation, were associated with a greater IRR for infection death than for other causes of death. Further research is needed to define why these risk factors are more strongly associated with infection death, so that more effective preventive strategies can be targeted to high-risk groups. British Heart Foundation.