Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study
Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study
Abstract BackgroundClinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate: (1) the risk of severe COVID-19 in those eligible for shielding, and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. MethodsAll 178578 diagnosed cases of COVID-19 in Scotland from 1 March 2020 to 18 February 2021 were matched for age, sex and primary care practice to 1744283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. ResultsWith those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 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. To test for causality, a case-crossover analysis was undertaken; with less recent exposure only (15 to 24 days before first testing positive) as reference category, the rate ratio associated with recent exposure only was 5.9 (95% CI 3.6 to 9.7). The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020. ConclusionsThe effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. For solid organ transplant recipients, in whom the efficacy of vaccines is uncertain, these results support a policy of offering vaccination to household contacts. Mitigating the impact of the epidemic requires control of nosocomial transmission.
McAllister David A、Lone Nazir、McMenamin Jim、McKeigue Paul M、Gribben Ciara、Bishop Jen、Colville Sam、Delvaux Joke、Goldberg David、Armstrong Matthew、Caldwell David、Robertson Chris、McGurnaghan Stuart、Colhoun Helen M、Hutchinson Sharon
Institute of Health and Wellbeing, University of Glasgow||Public Health ScotlandUsher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, Scotland. PM - Professor of Genetic Epidemiology and Statistical Genetics. NL - Clinical Senior Lecturer in Critical CarePublic Health ScotlandUsher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, Scotland. PM - Professor of Genetic Epidemiology and Statistical Genetics. NL - Clinical Senior Lecturer in Critical Care||Public Health ScotlandPublic Health ScotlandPublic Health ScotlandPublic Health ScotlandPublic Health ScotlandPublic Health ScotlandPublic Health ScotlandPublic Health ScotlandDepartment of Mathematics and Statistics, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ. CR - Professor of Public Health Epidemiology||Public Health ScotlandInstitute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh EH4 2XUC, Scotland. HC - AXA Chair in Medical Informatics and EpidemiologyInstitute of Genetics and Molecular Medicine, College of Medicine and Veterinary Medicine, University of Edinburgh, Western General Hospital Campus, Crewe Road, Edinburgh EH4 2XUC, Scotland. HC - AXA Chair in Medical Informatics and Epidemiology||Public Health ScotlandSchool of Health and Life Sciences, Glasgow Caledonian University. SH - Professor of Epidemiology and Population Health||Public Health Scotland
医药卫生理论医学研究方法预防医学
COVID-19 / prevention & controlTransplant RecipientNosocomial InfectionMatched Case Control Studies
McAllister David A,Lone Nazir,McMenamin Jim,McKeigue Paul M,Gribben Ciara,Bishop Jen,Colville Sam,Delvaux Joke,Goldberg David,Armstrong Matthew,Caldwell David,Robertson Chris,McGurnaghan Stuart,Colhoun Helen M,Hutchinson Sharon.Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study[EB/OL].(2025-03-28)[2025-04-26].https://www.medrxiv.org/content/10.1101/2021.03.02.21252734.点此复制
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