12 Being Non-Frail and Free From Cardiovascular Disease Reduces COVID-19 Risk in 269,164 Older UK Biobank Participants

Background Older adults are at increased risk of COVID-19, resulting in public health shielding measures for all adults over 70 in the UK Frailty has been proposed for risk stratification in COVID-19 with limited evidence Cardiovascular risk factors hypertension, diabetes and raised BMI have been associated with increased COVID-19 risk We sought to test if non-frail older adults with low cardiovascular risk had reduced COVID-19, to inform targeted shielding policies Methods Fried and Rockwood frailty were ascertained at UK Biobank baseline (2006-2010) and electronic frailty index(eFI) in primary care data to 2017* A cardiovascular disease risk score(CRS) consisting of smoking status, LDL-cholesterol, blood pressure, BMI, fasting glucose and physical activity was estimated at baseline Frailty (baseline and eFI;eFI alone) and CRS were tested in logistic models against COVID-19 status and COVID-19 mortality to 14th June 2020 adjusted for demographics and technical covariates Results N=269,164 UKB participants aged ≥65 at baseline (≥75years in 2020) 13 9% of COVID-19 positive were non-frail with low baseline CRS versus 41 8% frail with moderate/high CRS Being non-frail and having low CRS were independently associated with reduced COVID-19 The composite of non-frail with low CRS compared to frail with moderate/high CRS had significantly reduced COVID-19 risk (composite non-frail with low CRS HR 0 61;95% CI 0 45-0 84;p=0 0023;eFI non-frail with low CRS HR 0 16;95%CI 0 07-0 36;p value=9 9x10-6) and COVID-19 mortality (composite non-frail HR 0 28;95% CI 0 10-0 82;pvalue=0 02;eFI non-frail 0 07;95% CI 0 02-0 28;pvalue=0 00014) Conclusion These results show that the COVID-19 risk in non-frail older adults with low cardiovascular risk was up to 84% lower than in those who were frail with cardiovascular risk factors This could contribute to future work on stratification of shielding risk in older adults in future COVID-19 surges *Planned data updates prior to the conference should enable updates to 2020