Risk and protective factors for COVID-19 patients

IHW PhD student and doctor in training Sam Leighton describes the project that he and colleagues have devised to examine risk and protective factors for COVID-19 patients outside of the hospital setting

Dr S Leighton web version Prior to the COVID-19 crisis, I was just getting into the swing of my PhD first year, looking at outcome prediction in psychosis. However, as with the entire planet, life changed dramatically in March. As a doctor in training, I was recalled back to help out with the anticipated surge in activity brought on by COVID-19. There is plenty of evidence, anecdotally and in the media, of the immense burden the crisis is placing on people’s mental health.

Back working for the NHS, my mind turned to the myriad of information and open source data being generated about COVID-19. Morbid international league tables detailing infection rates and deaths, the emerging disaster in the UK’s care homes mirrored by equally terrible developments in our elderly patient population, led me to wonder whether I could make some meaning out of the deluge of information. There had been important contributions to our understanding of COVID-19 in patients in hospital, but precious little had been written about those out of hospital, especially in care homes.

I began trawling the internet and in conjunction with my wife Danielle Leighton, a clinical lecturer in neurology at the University of Glasgow, alongside my friend and senior lecturer at the University of Birmingham, Pavan Mallikarjun, began compiling a list of possible risk and protective factors for COVID-19 mortality. We sought to model these factors against COVID-19 deaths broken down by local authority, equivalent to councils in Scotland. This is the most granular level that the respective governments of the UK release COVID-19 statistics.

Soon the initial idea developed into a larger research project involving a team effort with fellow Glasgow colleagues, Breda Cullen, senior lecturer, Jonathan Cavanagh, professor, and James Herron, PhD student and fellow psychiatrist, plus, vital collaborators at Birmingham, Rachel Upthegrove, professor, and Georgios Gkoutos, professor and also associate director at Health Data Research UK.
Our eventual manuscript entitled “Risk Factors for COVID-19 versus non-COVID-19 related in-hospital and community deaths by Local Authority District in Great Britain” has been recently uploaded to medRxiv preprint server and submitted for peer-review. In this ecological study, we outline a multivariable analysis of putative risk factors for local authority COVID-19 deaths utilising open data. Our study is unique in considering the risk factors for COVID-19 death in relation to all deaths except COVID-19, and, for studying COVID-19 deaths across all settings, including care homes. The principle findings are the predictive effect of increased air pollution in the form of fine particulate matter and the protective effect of increased air temperature on COVID-19 deaths across all settings. Looking at the settings individually, a local authority being in Scotland was a risk factor increased COVID-19 care home deaths, while, a higher proportion of a local authority’s population being from an ethnic minority was a risk factor for COVID-19 hospital deaths.

As an ecological study, the results cannot be directly extrapolated to individuals. However, we hope the analysis may generate useful hypotheses to inform future research. I am personally glad that my developing research skills have been able to be put to use on something topical and hopefully worthwhile in the present crisis.

Sam Leighton
Clinical Lecturer in General Psychiatry (Mental Health and Wellbeing)

First published: 14 March 2018

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