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Association of Age, Gender, Deprivation, Urbanicity, Ethnicity, and Smoking with a Positive Test for COVID-19 in an English Primary Care Surveillance Network: Cross Sectional Study of the First 500 Cases

20 Pages Posted: 12 May 2020

See all articles by Simon de Lusignan

Simon de Lusignan

University of Oxford; University of Surrey - Department of Clinical & Experimental Medicine; Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)

Jienchi Dorward

University of Oxford - Nuffield Department of Primary Care Health Sciences

Ana Correa

University College London - Institute for Global Health

Nicholas Jones

University of Oxford - Nuffield Department of Primary Care Health Sciences

Oluwafunmi Akinyemi

University of Oxford - Nuffield Department of Primary Care Health Sciences

Gayatri Amirthalingam

Public Health England - Immunisation and Countermeasures Division

Nick Andrews

Public Health England Colindale

Rachel Byford

University of Oxford - Nuffield Department of Primary Care Health Sciences

Gavin Dabrera

Public Health England - National Infection Service

Alex Elliot

Government of the United Kingdom - Public Health England

Joanna Ellis

Government of the United Kingdom - Public Health England

Filipa Ferreira

University of Oxford - Nuffield Department of Primary Care Health Sciences

Jamie Lopez Bernal

Public Health England Colindale

Cecilia Okusi

University of Oxford - Nuffield Department of Primary Care Health Sciences

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department

Julian Sherlock

University of Oxford - Nuffield Department of Primary Care Health Sciences

Gillian Smith

University of Oxford - Nuffield Department of Primary Care Health Sciences

Gary Howsam

Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC)

Maria Zambon

Public Health England - Virus Reference Department

Richard Hobbs

University of Oxford - Nuffield Department of Primary Care Health Sciences; University of Birmingham

Mark Joy

University of Oxford - Nuffield Department of Primary Care Health Sciences

John Williams

University of Oxford - Nuffield Department of Primary Care Health Sciences

More...

Abstract

Background: There are few epidemiological studies of community cases in the current coronavirus-2019 (COVID-19) pandemic. We report on the first 500 COVID-19 cases identified through United Kingdom primary care surveillance and describe risk factors for testing COVID-19 positive.   

Methods: The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), is a nationally representative primary care sentinel network sharing pseudonymised data, including virological test data for COVID-19. We used multivariable logistic regression models with multiple imputation to identify risk factors for positive COVID-19 tests within this surveillance programme.  

Findings: We identified 3,802 COVID-19 results between 28/01/20 and 04/04/2020, 587 were positive. Greater odds of testing COVID-19 positive included: working-age people (40-64years) and older age, (≥75 years) versus 0-17 year olds (adjusted odds ratio [aOR] 5.26, 95%CI:3.26-8.49 and 5.17,95%CI:2.99-8.92, respectively); male gender (aOR 1.56, 95%CI:1.28-1.90); black and mixed ethnicity compared with white (aOR 4.55, 95%CI:2.55-8.10 and 1.84 95%CO:1.1-3.14, respectively));  urban compared with rural areas (aOR 4.58, 95%CI:3.57-5.88); people with chronic kidney disease (CKD) (aOR 1.88, 95%CI:1.29-2.75) and increasing body mass index (aOR 1.02, 95%CI:1.00-1.03). People in the least deprived deprivation quintile had lower odds of a positive test (aOR 0.49 95%CI:0.36-0.65) as did current smokers (aOR 0.53, 95%CI:0.38-0.74).   

Interpretation: A positive COVID-19 test result in primary care was associated with similar risk factors for severe outcomes seen in hospital settings, with the exception of smoking. We provide early evidence of potential sociodemographic factors associated with a positive test, including ethnicity, deprivation, population density, and CKD.  

Funding Statement: Public Health England provides the core funding for RCGP RSC, no specific funding was provided for this analysis.

Declaration of Interests: The authors have no competing interests. SdeL is the Director of the Oxford RCGP RSC, RB, JS, FF, EK and GH are part funded by PHE; and CO and AC by a Wellcome Biomedical resources grant (212763/Z/18/Z). JD is funded by Wellcome Trust (216421/Z/19/Z).

Ethics Approval Statement: This study was approved by the RCGP RSC study approval committee and was classified as a study of “usual practice”. Therefore, no further ethical approval was required.

Keywords: General practice; medical record systems; computerized; sentinel surveillance; coronavirus; infections; pandemics

Suggested Citation

de Lusignan, Simon and Dorward, Jienchi and Correa, Ana and Jones, Nicholas and Akinyemi, Oluwafunmi and Amirthalingam, Gayatri and Andrews, Nick and Byford, Rachel and Dabrera, Gavin and Elliot, Alex and Ellis, Joanna and Ferreira, Filipa and Bernal, Jamie Lopez and Okusi, Cecilia and Ramsay, Mary E. and Sherlock, Julian and Smith, Gillian and Howsam, Gary and Zambon, Maria and Hobbs, F.D. Richard and Joy, Mark and Williams, John, Association of Age, Gender, Deprivation, Urbanicity, Ethnicity, and Smoking with a Positive Test for COVID-19 in an English Primary Care Surveillance Network: Cross Sectional Study of the First 500 Cases (4/15/2020). Available at SSRN: https://ssrn.com/abstract=3578782 or http://dx.doi.org/10.2139/ssrn.3578782

Simon De Lusignan (Contact Author)

University of Oxford ( email )

Eagle House,
Walton Well Road,
Oxford, OX2 6ED
United Kingdom

HOME PAGE: http://https://orchid.phc.ox.ac.uk

University of Surrey - Department of Clinical & Experimental Medicine ( email )

Guildford
United Kingdom

Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) ( email )

30 Euston Square
London
United Kingdom

Jienchi Dorward

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Ana Correa

University College London - Institute for Global Health ( email )

United Kingdom

Nicholas Jones

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Oluwafunmi Akinyemi

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Gayatri Amirthalingam

Public Health England - Immunisation and Countermeasures Division ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Nick Andrews

Public Health England Colindale ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Rachel Byford

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Gavin Dabrera

Public Health England - National Infection Service ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Alex Elliot

Government of the United Kingdom - Public Health England ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Joanna Ellis

Government of the United Kingdom - Public Health England ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Filipa Ferreira

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Jamie Lopez Bernal

Public Health England Colindale ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

Cecilia Okusi

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Mary E. Ramsay

Public Health England - Immunisation, Hepatitis, and Blood Safety Department ( email )

United Kingdom

Julian Sherlock

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Gillian Smith

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

Gary Howsam

Royal College of General Practitioners - Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) ( email )

30 Euston Square
London
United Kingdom

Maria Zambon

Public Health England - Virus Reference Department ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

F.D. Richard Hobbs

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

University of Birmingham ( email )

Mark Joy

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

John Williams

University of Oxford - Nuffield Department of Primary Care Health Sciences ( email )

Oxford
United Kingdom

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