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Household overcrowding and risk of SARS-CoV-2: analysis of the Virus Watch prospective community cohort study in England and Wales

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  • Robert W Aldridge
  • Helen Pineo
  • Ellen Fragaszy
  • Max T Eyre
  • Jana Kovar
  • Vincent Nguyen
  • Sarah Beale
  • Thomas Byrne
  • Anna Aryee
  • Colette Smith
  • Delan Devakumar
  • Jonathon Taylor
  • Srinivasa Vittal Katikireddi
  • Wing Lam Erica Fong
  • Cyril Geismar
  • Parth Patel
  • Madhumita Shrotri
  • Isobel Braithwaite
  • Nicholas Patni
  • Annalan M D Navaratnam
  • And 2 others
  • Anne M Johnson
  • Andrew Hayward
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Article number347
<mark>Journal publication date</mark>15/12/2021
<mark>Journal</mark>Wellcome Open Research
Volume6
Publication StatusPublished
<mark>Original language</mark>English

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-valueConclusion: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.