Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

Paul M. Mckeigue; David A. McAllister; David Caldwell; Ciara Gribben; Jen Bishop; Stuart McGurnaghan; Matthew Armstrong; Joke Delvaux; Sam Colville; Sharon Hutchinson; Chris Robertson; Nazir Lone; Jim McMenamin; David Goldberg; Helen M. Colhoun

doi:10.1186/s12916-021-02021-5

Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

Paul M. Mckeigue, David A. McAllister, David Caldwell, Ciara Gribben, Jen Bishop, Stuart McGurnaghan, Matthew Armstrong, Joke Delvaux, Sam Colville, Sharon Hutchinson, Chris Robertson, Nazir Lone, Jim McMenamin, David Goldberg, Helen M. Colhoun

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Abstract

Background: Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. Methods: Inamatchedcase-controldesign,all178,578diagnosedcasesofCOVID-19inScotlandfrom1March2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression.
Results: Withthosewithoutriskconditionsasreferencecategory,theunivariaterateratioforsevereCOVID-19was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020.
Conclusions: Theeffectivenessofshieldingvulnerableindividualswaslimitedbytheinabilitytocontroltransmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.

Original language	English
Article number	149
Pages (from-to)	1-13
Number of pages	13
Journal	BMC Medicine
Volume	19
DOIs	https://doi.org/10.1186/s12916-021-02021-5
Publication status	Published - 23 Jun 2021

Keywords

adult
COVID-19/complications
case-control studies
child
child, preschool
critical care
female
humans
logistic models
male
pregnancy
primary health care
risk factors
SARS-CoV-2
Scotland/epidemiology
nosocomial infection
transplant recipient
matched case control Studies
COVID-19/prevention and control

ASJC Scopus subject areas

General Medicine

Documents and Links

10.1186/s12916-021-02021-5

McKeigue, P.M. et al (2021) Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study
© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/
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Mckeigue, P. M., McAllister, D. A., Caldwell, D., Gribben, C., Bishop, J., McGurnaghan, S., Armstrong, M., Delvaux, J., Colville, S., Hutchinson, S., Robertson, C., Lone, N., McMenamin, J., Goldberg, D., & Colhoun, H. M. (2021). Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study. BMC Medicine, 19, 1-13. Article 149. https://doi.org/10.1186/s12916-021-02021-5

@article{f53ae134eddc47c48c60bc7998f79360,

title = "Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study",

abstract = "Background: Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. Methods: Inamatchedcase-controldesign,all178,578diagnosedcasesofCOVID-19inScotlandfrom1March2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression.Results: Withthosewithoutriskconditionsasreferencecategory,theunivariaterateratioforsevereCOVID-19was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020.Conclusions: Theeffectivenessofshieldingvulnerableindividualswaslimitedbytheinabilitytocontroltransmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.",

keywords = "adult, COVID-19/complications, case-control studies, child, child, preschool, critical care, female, humans, logistic models, male, pregnancy, primary health care, risk factors, SARS-CoV-2, Scotland/epidemiology, nosocomial infection, transplant recipient, matched case control Studies, COVID-19/prevention and control",

author = "Mckeigue, {Paul M.} and McAllister, {David A.} and David Caldwell and Ciara Gribben and Jen Bishop and Stuart McGurnaghan and Matthew Armstrong and Joke Delvaux and Sam Colville and Sharon Hutchinson and Chris Robertson and Nazir Lone and Jim McMenamin and David Goldberg and Colhoun, {Helen M.}",

note = "Acceptance from webpage OA journal",

year = "2021",

month = jun,

day = "23",

doi = "10.1186/s12916-021-02021-5",

language = "English",

volume = "19",

pages = "1--13",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

}

Mckeigue, PM, McAllister, DA, Caldwell, D, Gribben, C, Bishop, J, McGurnaghan, S, Armstrong, M, Delvaux, J, Colville, S, Hutchinson, S, Robertson, C, Lone, N, McMenamin, J, Goldberg, D & Colhoun, HM 2021, 'Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study', BMC Medicine, vol. 19, 149, pp. 1-13. https://doi.org/10.1186/s12916-021-02021-5

TY - JOUR

T1 - Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

AU - Mckeigue, Paul M.

AU - McAllister, David A.

AU - Caldwell, David

AU - Gribben, Ciara

AU - Bishop, Jen

AU - McGurnaghan, Stuart

AU - Armstrong, Matthew

AU - Delvaux, Joke

AU - Colville, Sam

AU - Hutchinson, Sharon

AU - Robertson, Chris

AU - Lone, Nazir

AU - McMenamin, Jim

AU - Goldberg, David

AU - Colhoun, Helen M.

N1 - Acceptance from webpage OA journal

PY - 2021/6/23

Y1 - 2021/6/23

N2 - Background: Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. Methods: Inamatchedcase-controldesign,all178,578diagnosedcasesofCOVID-19inScotlandfrom1March2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression.Results: Withthosewithoutriskconditionsasreferencecategory,theunivariaterateratioforsevereCOVID-19was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020.Conclusions: Theeffectivenessofshieldingvulnerableindividualswaslimitedbytheinabilitytocontroltransmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.

AB - Background: Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. Methods: Inamatchedcase-controldesign,all178,578diagnosedcasesofCOVID-19inScotlandfrom1March2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression.Results: Withthosewithoutriskconditionsasreferencecategory,theunivariaterateratioforsevereCOVID-19was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020.Conclusions: Theeffectivenessofshieldingvulnerableindividualswaslimitedbytheinabilitytocontroltransmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.

KW - adult

KW - COVID-19/complications

KW - case-control studies

KW - child

KW - child, preschool

KW - critical care

KW - female

KW - humans

KW - logistic models

KW - male

KW - pregnancy

KW - primary health care

KW - risk factors

KW - SARS-CoV-2

KW - Scotland/epidemiology

KW - nosocomial infection

KW - transplant recipient

KW - matched case control Studies

KW - COVID-19/prevention and control

U2 - 10.1186/s12916-021-02021-5

DO - 10.1186/s12916-021-02021-5

M3 - Article

C2 - 34158021

SN - 1741-7015

VL - 19

SP - 1

EP - 13

JO - BMC Medicine

JF - BMC Medicine

M1 - 149

ER -

Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

Abstract

Keywords

ASJC Scopus subject areas

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