Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study

Anuradhaa Subramanian, Astha Anand, Nicola Adderley, Kelvin Okoth, Konstantinos Toulis, Krishna Gokhale, Chris Sainsbury, Michael W OʼReilly, Wiebke Arlt, Krishnarajah Nirantharakumar

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Abstract

Objective: Several recent observational studies have linked metabolic comorbidities to an increased risk from COVID- 19. Here we investigated whether women with PCOS are at an increased risk of COVID-19 infection. Design: Population-based closed cohort study between 31 January 2020 and 22 July 2020 in the setting of a UK primary care database (The Health Improvement Network, THIN). Methods: The main outcome was the incidence of COVID-19 coded as suspected o r confirmed by the primary care provider. We used Cox proportional hazards regression model with stepwise inclusion of explanatory variables (age, BMI, impaired glucose regulation, androgen excess, anovul ation, vitamin D deficiency, hypertension, and cardiovascular disease) to provide unadjusted and adjusted hazard risks (HR) of COVID-19 infection among women with PCOS compared to women without PCOS. Results: We identified 21 292 women with a coded diagnosis of PCO/PCOS an d randomly selected 78 310 aged and general practice matched control women. The crude COVID-19 inci dence was 18.1 and 11.9 per 1000 person-years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without PCO S (HR: 1.51 (95% CI: 1.27-1.80), P < 0.001). After adjusting for age and BMI, HR reduced to 1.36 (1.14-1.63) ], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased risk of COVID-19 (aHR: 1.28 (1.05-1.56 ), P = 0.015). Conclusion: Women with PCOS are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to infection control measures during the COVID-19 pandemic. Significance statement: Women with polycystic ovary syndrome (PCOS) have an increased risk of cardio-metabolic disease, which have been identified as a risk factor for COVID-1 9. To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, we carried out a population-based closed cohort study in the UK during its first wave of the SARS-CoV-2 pandemic (January to July 2020), including 21 292 women with PCOS and 78 310 controls matched for sex, age and general pract ice location. Results revealed a 52% increased risk of COVID-19 infection in women with PCOS, which remained increased at 28% above controls after adjustment for age, BMI, impaired glucose regulation and other explanatory variables.

Original languageEnglish
Pages (from-to)637-645
Number of pages9
JournalEuropean Journal of Endocrinology
Volume184
Issue number5
DOIs
Publication statusPublished - 1 May 2021

Bibliographical note

Funding Information:
This study was funded by Health Data Research UK and supported by the

Funding Information:
Wellcome Trust ( 阀nvestigator ?rant WT20?4?2/Z/?7/Z, to W A) and the Health Research Board (HRB; Emerging Clinician Scientist Award ECSA?2020?00?, to M W O’R). WA receives support from the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham (Grant Reference Number BRC-1215-20009). The views expressed are those of the authors and not necessarily those of the NIHR UK or the Department of Health and Social Care UK.

Funding Information:
This study was funded by Health Data Research UK and supported by the Wellcome Trust (Investigator Grant WT209492/Z/17/Z, to W A) and the Health Research Board (HRB; Emerging Clinician Scientist Award ECSA-2020-001, to M W O'R). WA receives support from the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham (Grant Reference Number BRC-1215-20009). The views expressed are those of the authors and not necessarily those of the NIHR UK or the Department of Health and Social Care UK.

Publisher Copyright:
© 2021 The authors.

Keywords

  • Adult
  • Age Factors
  • Body Mass Index
  • COVID-19/epidemiology
  • Cardiovascular Diseases/epidemiology
  • Diabetes Mellitus/epidemiology
  • Female
  • Humans
  • Hypertension/epidemiology
  • Middle Aged
  • Obesity/epidemiology
  • Polycystic Ovary Syndrome/epidemiology
  • Prediabetic State/epidemiology
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Testosterone/metabolism
  • United Kingdom/epidemiology
  • Vitamin D Deficiency/epidemiology

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