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

Aldridge, Robert W and Pineo, Helen and Fragaszy, Ellen and Eyre, Max T and Kovar, Jana and Nguyen, Vincent and Beale, Sarah and Byrne, Thomas and Aryee, Anna and Smith, Colette and Devakumar, Delan and Taylor, Jonathon and Katikireddi, Srinivasa Vittal and Fong, Wing Lam Erica and Geismar, Cyril and Patel, Parth and Shrotri, Madhumita and Braithwaite, Isobel and Patni, Nicholas and Navaratnam, Annalan M D and Johnson, Anne M and Hayward, Andrew (2021) Household overcrowding and risk of SARS-CoV-2 : analysis of the Virus Watch prospective community cohort study in England and Wales. Wellcome Open Research, 6: 347. ISSN 2398-502X

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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.