key: cord-1004779-fnk6j74i
authors: Roy, Abhipsha Sur; Joshi, Amol
title: Response to ‘Multimorbidity and SARS-CoV-2 infection in UK Biobank’
date: 2020-06-24
journal: Diabetes Metab Syndr
DOI: 10.1016/j.dsx.2020.06.033
sha: 6f6944cca5a711d4f2e7a16fc8b89a179588512c
doc_id: 1004779
cord_uid: fnk6j74i

nan

Dear Editor,

We read with interest the recent article in this journal by Chudasama et al. [1] which analysed health information from 329 UK Biobank participants who tested positive for COVID-19 and were diagnosed with two or more pre-existing chronic conditions.

The study highlighted that pre-existing "cardiometabolic" morbidities were the most prevalent, featuring 5 out of the 10 conditions being measured. However, we note that the authors' grouping of these conditions into broad categories masks the significant range of disease severity within the population. A large scale study found Stage 2 and Stage 3 hypertension to be associated with significantly higher mortality than Stage 1 hypertension [2] . Therefore, we argue that dividing conditions such as hypertension into well-defined stages of severity will contribute to a greater understanding of which subgroups of the population are more susceptible to COVID-19 infection. Furthermore, it is well established that uncontrolled diabetes is a key risk factor in the development of respiratory disease [3] . It is possible therefore that the significant proportion of diabetics in the COVID-positive sample may disproportionately reflect those with poorer glycaemic control.

Whilst the ethnic stratification of the sample is crudely representative of UK demographics, we highlight that COVID-19 disproportionately affects minority populations [4] . Studies have shown that British South Asians have higher prevalence of insulin resistance and metabolic disease than their white counterparts, with concomitant effects on cardiovascular comorbidity [5, 6] . Given that COVID-19 is a global disease, it may be the case that the prevalence of these morbidity pairings are not uniformly seen in other ethnic populations.

The authors have given us valuable insight into the complex interplay between pre-existing disease and COVID susceptibility. We believe that future work conducted on this topic should assess comorbidity severity when determining potential risk factors for COVID-19. Moreover, in order to build a more accurate representation of the aetiology of COVID-19, multicentre studies involving heterogeneous ethnic populations should be conducted with the aim of further improving our knowledge of this novel pathogen.

Multimorbidity and SARS-CoV-2 infection in UK Biobank

High blood pressure and allcause and cardiovascular disease mortalities in community-dwelling older adults

Patients diagnosed with diabetes are at increased risk for asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and pneumonia but not lung cancer

Coronavirus (COVID-19) related deaths by ethnic group, England and Wales -Office for National Statistics

Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians

The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited) -A prospective population-based study