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Original research
Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK)
  1. Hayley Holt1,
  2. Mohammad Talaei1,
  3. Matthew Greenig1,
  4. Dominik Zenner1,
  5. Jane Symons2,
  6. Clare Relton1,
  7. Katherine S Young3,
  8. Molly R Davies3,
  9. Katherine N Thompson3,
  10. Jed Ashman1,
  11. Sultan Saeed Rajpoot1,
  12. Ahmed Ali Kayyale1,
  13. Sarah El Rifai1,
  14. Philippa J Lloyd1,
  15. David Jolliffe1,
  16. Olivia Timmis1,
  17. Sarah Finer1,
  18. Stamatina Iliodromiti1,
  19. Alec Miners4,
  20. Nicholas S Hopkinson5,
  21. Bodrul Alam6,
  22. Graham Lloyd-Jones7,
  23. Thomas Dietrich8,
  24. Iain Chapple8,
  25. Paul E Pfeffer1,
  26. David McCoy1,
  27. Gwyneth Davies9,
  28. Ronan A Lyons9,
  29. Christopher Griffiths1,
  30. Frank Kee10,
  31. Aziz Sheikh11,
  32. Gerome Breen3,
  33. Seif O Shaheen1,
  34. Adrian R Martineau1
  1. 1 Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2 Jane Symons Media, London, UK
  3. 3 Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  4. 4 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  5. 5 National Heart and Lung Institute, Imperial College London, London, UK
  6. 6 Edenfield Road Surgery, Rochdale, UK
  7. 7 Department of Radiology, Salisbury District Hospital, Salisbury, UK
  8. 8 School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
  9. 9 Population Data Science, Swansea University Medical School, Swansea, UK
  10. 10 Centre for Public Health Research (NI), Queen’s University Belfast, Belfast, UK
  11. 11 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor Adrian R Martineau, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK; a.martineau{at}


Background Risk factors for severe COVID-19 include older age, male sex, obesity, black or Asian ethnicity and underlying medical conditions. Whether these factors also influence susceptibility to developing COVID-19 is uncertain.

Methods We undertook a prospective, population-based cohort study (COVIDENCE UK) from 1 May 2020 to 5 February 2021. Baseline information on potential risk factors was captured by an online questionnaire. Monthly follow-up questionnaires captured incident COVID-19. We used logistic regression models to estimate multivariable-adjusted ORs (aORs) for associations between potential risk factors and odds of COVID-19.

Results We recorded 446 incident cases of COVID-19 in 15 227 participants (2.9%). Increased odds of developing COVID-19 were independently associated with Asian/Asian British versus white ethnicity (aOR 2.28, 95% CI 1.33 to 3.91), household overcrowding (aOR per additional 0.5 people/bedroom 1.26, 1.11 to 1.43), any versus no visits to/from other households in previous week (aOR 1.31, 1.06 to 1.62), number of visits to indoor public places (aOR per extra visit per week 1.05, 1.02 to 1.09), frontline occupation excluding health/social care versus no frontline occupation (aOR 1.49, 1.12 to 1.98) and raised body mass index (BMI) (aOR 1.50 (1.19 to 1.89) for BMI 25.0–30.0 kg/m2 and 1.39 (1.06 to 1.84) for BMI >30.0 kg/m2 versus BMI <25.0 kg/m2). Atopic disease was independently associated with decreased odds (aOR 0.75, 0.59 to 0.97). No independent associations were seen for age, sex, other medical conditions, diet or micronutrient supplement use.

Conclusions After rigorous adjustment for factors influencing exposure to SARS-CoV-2, Asian/Asian British ethnicity and raised BMI were associated with increased odds of developing COVID-19, while atopic disease was associated with decreased odds.

Trial registration number Registry (NCT04330599).

  • COVID-19
  • clinical epidemiology
  • asthma epidemiology
  • allergic lung disease

Data availability statement

Data are available upon reasonable request. Deidentified participant data are available from the corresponding author ( upon reasonable request, subject to the terms of Research Ethics Committee approval.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available upon reasonable request. Deidentified participant data are available from the corresponding author ( upon reasonable request, subject to the terms of Research Ethics Committee approval.

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  • HH, MT, SOS and ARM contributed equally.

  • Contributors ARM wrote the study protocol, with input from HH, MT, CR, GB and SOS. HH, MT, JS, CR, KSY, MRD, KNT, SF, SI, AM, PEP, GL-J, TD, IC, DM, GD, RAL, CG, FK, AS, GB, SOS and ARM contributed to questionnaire development and design. HH coordinated and managed the study, with input from ARM, MT, JS and SOS. HH, JS, ARM, SOS, NSH, OT and BA supported recruitment. MT, HH, MG, MRD, KNT, SSR, AAK, SER, PJL and DJ contributed to data management and coding medication data. Statistical analyses were done by MT, with input from SOS, ARM, MG and HH. ARM wrote the first draft of the report. All authors revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved.

  • Funding This study was supported by a grant from Barts Charity to ARM and CG (ref MGU0466). The work was carried out with the support of BREATHE—The Health Data Research Hub for Respiratory Health (MC_PC_19004) in partnership with SAIL Databank. BREATHE is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. MT is supported by a grant from the Rosetrees Trust and The Bloom Foundation (ref: M771).

  • Disclaimer The views expressed are those of the authors and not necessarily those of Barts Charity, BREATHE or Health Data Research UK.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.