Abstract
Background: Household overcrowding is associated with increased risk of infectious diseases across contexts and countries. Limited data exist linking household overcrowding and risk of COVID-19. We used data collected from the Virus Watch cohort to examine the association between overcrowded households and SARS-CoV-2. Methods: The Virus Watch study is a household community cohort of acute respiratory infections in England and Wales. We calculated overcrowding using the measure of persons per room for each household. We considered two primary outcomes: PCR-confirmed positive SARS-CoV-2 antigen tests and laboratory-confirmed SARS-CoV-2 antibodies. We used mixed-effects logistic regression models that accounted for household structure to estimate the association between household overcrowding and SARS-CoV-2 infection. Results:26,367 participants were included in our analyses. The proportion of participants with a positive SARS-CoV-2 PCR result was highest in the overcrowded group (9.0%; 99/1,100) and lowest in the under-occupied group (4.2%; 980/23,196). In a mixed-effects logistic regression model, we found strong evidence of an increased odds of a positive PCR SARS-CoV-2 antigen result (odds ratio 2.45; 95% CI:1.43-4.19; p-value=0.001) and increased odds of a positive SARS-CoV-2 antibody result in individuals living in overcrowded houses (3.32; 95% CI:1.54-7.15; p-value<0.001) compared with people living in under-occupied houses. Conclusion:Public health interventions to prevent and stop the spread of SARS-CoV-2 should consider the risk of infection for people living in overcrowded households and pay greater attention to reducing household transmission.
Highlights
Household overcrowding is associated with increased risk of infectious diseases across cultures and countries[1]
We estimate that overcrowded households have between 2- and 4-times the odds of polymerase chain reaction (PCR)-confirmed SARS-CoV-2 and anti-N total immunoglobulin assay antibody positivity compared to under-occupied households
We found that people in accommodation considered balanced, where the number of rooms was equal to the number of people, were at increased risk of PCR confirmed SARS-CoV-2 compared to under-occupied houses
Summary
Household overcrowding is associated with increased risk of infectious diseases across cultures and countries[1]. According to the English Housing Survey, approximately 787,000 (3%) of English households are overcrowded with unequal distribution across regions and social groups[5]. A total of 7% of the most deprived households were overcrowded compared with less than half a per cent of the least deprived households. Household overcrowding is associated with increased risk of infectious diseases across contexts and countries. Limited data exist linking household overcrowding and risk of COVID-19. We used data collected from the Virus Watch cohort to examine the association between overcrowded households and SARS-CoV-2. Reviewer Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article
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