Susceptibility to and severity of SARS-CoV-2 infection according to prescription drug use–an observational study of 46,506 Danish healthcare workers

It is not well investigated whether exposure to specific drug classes is associated with COVID-19. We investigated the risk of SARS-CoV-2 infection and severe COVID-19 among healthcare workers according to prescription drug use. We conducted an observational study among Danish healthcare workers. SA...

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Published in:	PloS one Vol. 19; no. 11; p. e0311260
Main Authors:	Eiken, Aleksander, Bliddal, Sofie, Villumsen, Marie, Iversen, Kasper K., Bundgaard, Henning, Hasselbach, Rasmus B., Kristensen, Jonas H., Nielsen, Pernille B., Pries-Heje, Mia M., Knudsen, Andreas D., Fogh, Kamille, Norsk, Jakob B., Andersen, Ove, Fischer, Thea K., Dessau, Ram B., Ostrowski, Sisse R., Torp-Pedersen, Christian, Ditlev, Sisse B., Gybel-Brask, Mikkel, Sørensen, Erik, Harritshøj, Lene H., Folke, Fredrik, Benfield, Thomas, Engsig, Frederik N., Poulsen, Henrik E., Ullum, Henrik, Feldt-Rasmussen, Ulla, Nielsen, Susanne D., Rungby, Jørgen
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 27.11.2024 Public Library of Science (PLoS)
Subjects:	Adult Allergic diseases Asthma Biology and life sciences Body mass index Calcium Calcium channel blockers Calcium Channel Blockers - therapeutic use Calcium channels Cardiovascular disease Case-Control Studies Chronic illnesses Chronic infection COVID-19 COVID-19 - epidemiology Denmark - epidemiology Diabetes Disease prevention Disease Susceptibility Disease transmission Diuretics Drug interaction Drug use Drugs Enzymes Evaluation Exposure Female Health aspects Health care Health Personnel Health risks Hospitals Humans Hypertension Immune system Infections Kidney diseases Lung diseases Male Medical personnel Medicine and health sciences Middle Aged Observational studies Occupational exposure Pandemics People and Places Prescription drugs Prescription Drugs - therapeutic use Questionnaires Regression analysis Research and Analysis Methods Respiratory tract diseases Risk assessment Risk Factors Risk taking SARS-CoV-2 - isolation & purification Self report Severe acute respiratory syndrome coronavirus 2 Severity of Illness Index Social Sciences Statistical analysis Steroids Viral diseases Denmark
ISSN:	1932-6203, 1932-6203
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Summary:	It is not well investigated whether exposure to specific drug classes is associated with COVID-19. We investigated the risk of SARS-CoV-2 infection and severe COVID-19 among healthcare workers according to prescription drug use. We conducted an observational study among Danish healthcare workers. SARS-CoV-2 positivity was defined as a positive PCR/ELISA test throughout 2020 and severe COVID-19 as any above 48-hour hospitalization within 14 days after infection. Patient characteristics came from online surveys while data on SARS-CoV-2, drugs and hospitalizations came from Danish Health Registers. Infected individuals were matched with uninfected controls based on age, sex, and chronic diseases. Drug exposure was defined as any prescription redemption in the past six and one month(s) before infection for each drug class. Models assessing the risk of infection (conditional logistic regression) and severe COVID-19 (logistic regressions) versus drug usage were adjusted for BMI, smoking, alcohol, education, region, and patient contact when possible. We matched 5,710 SARS-CoV-2-infected cases with 57,021 controls. The odds of infection were reduced by calcium channel blocker (adjusted odds ratio (aOR) 0.81, 95% Confidence Interval (CI): 0.66–1.00) and vasoprotective drug (aOR 0.77, CI: 0.62–0.95) usage during the six months before infection compared to no usage. Exposure to antibacterials in the past month increased the odds of infection (aOR 1.27, CI: 1.09–1.48). Among infected participants, the odds of severe COVID-19 were higher with usage of almost any investigated drug, especially, diuretics (crude odds radio (OR) 4.82, CI:2.15–10.83), obstructive airway disease drugs (OR 4.49, CI: 2.49–8.08), and antibacterials (OR 2.74 CI:1.62–4.61). In conclusion, antibacterials were associated with more SARS-CoV-2 infections and calcium channel blockers with less. Once infected, users of prescription drugs had higher odds of developing severe COVID-19. These findings suggest a need for studies to clarify interactions between specific drug groups, behaviour, known risk factors, and disease susceptibility/severity.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 Competing Interests: S.B.’s research salary was sponsored by Sygesikring Danmark and the Capital Region of Denmark’s Research Foundation. K.I. received grants from Lundbeck Foundation to his institution [grant number R349-2020-731]. A.D.K has received a grant from The Danish Heart Foundation and a grant from the European Commission (EU 7th Framework [grant number 603266]). C.T-P. has received grants from Bayer and Novo- Nordisk for studies not related to the current study. F.F. has received research grant from the Novo Nordisk Foundation and an unrestricted research grant from the Laerdal Foundation to the Copenhagen EMS. S.D.N received an unrestricted research grants from the Novo Nordic Foundation, Augustinus Foundation, Kirsten and Freddy Johansen’s Foundation. U.F.R.’s research salary was sponsored by a grant from Kirsten and Freddy Johansen’s Foundation. A.E., M.V., H.B., J.R., R.B.H., J.H.K., P.B.N., M.M.P-H., K.F., J.B.N., O.A., T.K.F., R.B.D., S.R.O., S.B.D., M.G-B., E.S., L.H.H., T.B., F.N.E., H.E.P., H.U., and J.R. have no conflicts of interest to declare.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0311260