Impact of COVID-19 in patients with hepatobiliary and pancreatic conditions in East London
18 May 2021
Researchers from Barts Cancer Institute (BCI) at Queen Mary University of London have conducted a population-based study to explore the risk factors associated with COVID-19 susceptibility and survival in patients with a history of diseases of the liver, pancreas or biliary system - also known as hepato-pancreato-biliary (HPB) diseases - in East London.
Published recently in BMJ open, the study was the first multi-ethnic population-based study on COVID-19 in patients with HPB diseases.
In East London, the study cohort of over 15,000 patients diagnosed with HPB conditions had a three-fold higher infection rate than people without HPB conditions, indicating higher susceptibility of these patient groups to novel infection. In those with HPB conditions, the study found the following factors independently to pose higher odds of acquiring COVID-19 infection:
- Being male
- Black ethnicity
- Pre-existing moderate to severe liver conditions
- Common medical conditions including diabetes, hypertension, hypercholesterolemia, cardiovascular disease, chronic pulmonary and renal disease
- Substance misuse
- History of vitamin D treatment
According to the study, the odds of death from COVID-19 were significantly high for men and Black people.
The researchers utilised cross-linked health record data from Barts Health NHS Trust and Discovery East London Data Service. Data were collected and processed under the East London Pancreatic Cancer Epidemiology (EL-PaC-Epidem) study at Barts Health NHS Trust, funded by the Medical Research Council through Health Data Research UK.
Dr Dayem Ullah, UKRI/Rutherford Research Fellow at BCI and lead researcher on the study, said: "Surprisingly, the most vulnerable patients - those with HPB cancers - had a low COVID-19 incidence rate in our study population, which may reflect the effectiveness of public health interventions such as shielding. However, at the same time, we noted a 17% death rate in this patient group (not due to COVID-19) in 6 months, perhaps indicating the unintended, but potentially inevitable, negative consequence of social distancing and reduced healthcare provisions for this group of patients as resources were diverted to those with COVID-19 infection."
The study covered the first four months of the pandemic in the UK, during which time East London was one of the worst affected areas in the UK with high COVID-19 infection and mortality rates.1, 2
Professor Claude Chelala, Professor of Bioinformatics, IADS Executive Board member and Principal Investigator on the study, said: "By analysing COVID-19 data in one of the most diverse and disadvantaged areas of the UK, this study showcases the strength of health informatics research at the Barts Cancer Institute with a strong focus on both patient GP and hospital data. It builds on our excellent track record in Biobanking and brings together data scientists, clinicians and - at the heart of it all - patients, without whom work like this is simply not possible. The patterns and clues we found in the data are key for clinical management and surveillance strategies."
Considerations for COVID-19 prevention strategies
Many of the risk factors associated with COVID-19 susceptibility and mortality identified in the study reflect the overall risk pattern in the general population; however, this study is one of the very few to report significant risk of COVID-19 infection for individuals with a history of substance misuse and vitamin D treatment. Current smokers in the study cohort appeared to have a lesser risk of COVID-19 infection than those who had never smoked, even after taking into account comorbidities – a finding that cannot be mechanistically explained.
The study reinforces the understanding of some of the important risk factors for COVID-19 but with regard to pre-existing HPB conditions, and may allow for stratification of those at high risk of COVID-19 infection. With a vaccination scheme now in place for COVID-19 in the UK and while some parts of the world are still burdened with rising COVID-19 infection and mortality rates, the findings may provide guidance for policymakers to accelerate prevention strategies to a clearly identified vulnerable population.
1London Datastore. Coronavirus (COVID-19) cases and vaccinations: greater London authority (Gla), 2020 https://data.london.gov.uk/dataset/coronavirus--covid-19--cases
2UK Government. Coronavirus cases in the UK: daily updated statistics, 2020. https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public