The Causes of Susceptibility of the Elderly to COVID-19 Pneumonia Under the Natural State Based on a Behavioural Perspective: A Retrospective Study Taking ,the Early Onset of the Disease in Wuhan,China, as an Example

: In the early epidemic of COVID-19 in Wuhan, the proportion of elderly patients 10 over 60 years was significantly higher than that of other populations. However, with the 11 implementation of strong social control measures, the proportion of which dropped rapidly 12 to the same level as that of middle-aged patients (40-59), which indicated that the elder s’ social 13 behavioural pattern may have some connections with the infection. A retrospective study was 14 carried out to investigate the behavioural patterns of different age groups before the social 15 distance control in Wuhan, to find out the relationship between them and the infection under 16 the nature state, and furthermore, to put forward targeted suggestions to enhance the 17 resistance of the elderly to public health emergencies. To carry out the research, social survey, 18 one-way ANOVA and logistic regression models were utilized. The results showed that the 19 elderly had more social activities, more offline shopping, more travels by semi-public 20 transportation, and the factors below had significant impacts on the infection (P<0.05): the 21 level of indoor entertainment, the frequency of going to convenience stores or markets, the 22 frequency of walking, and the level of protection. Besides, suggestions were proposed, 23 including controlling the social distance of the elderly, developing senior-friendly shopping 24 platforms, advocating tailored car travel, etc. This study could provide data and theoretical 25 support for government's regulatory actions, enrich epidemiological theories of transmission 26 routes based on behaviour, and improve the adaptability of the elderly to public health 27 emergencies.

Jan., the proportion of the elderly people who were diagnosed with COVID-19 declined slightly, 51 but it was still higher than other age groups in overall hospitalized patients. On 10th Apr., the 52 elderly over 60 years old accounted for 42.4% of the total infected people in Wuhan. The

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The control measures in Wuhan had a significant effect and showed that the elderly were 67 not more susceptible than other age groups after restricting social behaviour. A study also 68 showed that, although the elderly was susceptible to infectious diseases [3], COVID-19 was 69 common in all age groups.

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By comparative analysis of the proportion of elderly patients before and after social 71 control in Wuhan, we put forward the following hypothesis: behaviour of the elderly under 72 the nature state was different from that of other age people, which was one of the main reasons 73 why elders were more likely to suffer from the disease. patterns and the distribution of leisure service facilities [22]. Shan

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To sum up, existing research results showed that COVID-19 was mainly transmitted 102 through airborne droplets and contact in people's daily activities such as socializing, shopping 103 and transportation, etc. The elderly were more likely to be infected due to their poor health and 104 negative attitude towards the epidemic. There was still a lack of research on the relationship 105 between the high infection rate of the elderly and their daily behaviours, and few scholars had 106 conducted in-depth research on the specific behaviours that may lead to higher infection rate 107 in social interaction, shopping and transportation.

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The paper attempts to analyze the link between different behavioural patterns under the questionnaire was designed in terms of shopping, social life, travel, and protective 111 measures, etc. The data were collected through the Internet and telephone. To determine the 112 significance of behavioural differences between the elderly and the middle-aged, we used a 113 one-way ANOVA. The logistic regression model was introduced to explore the factors that 114 could have had the greatest influence on the disease state under various behaviours and to 115 prove the correlation between the disease state and behavioural patterns. Finally, considering 116 the effectiveness of policies implemented in Wuhan during the epidemic, some suggestions 117 and policy supplements were put forward to improve the behaviour of the elderly. This article 118 is expected to provide data and theoretical support for the government's regulatory actions, 119 enrich epidemiological theories of transmission routes based on behaviour, and improve the 120 adaptability of the elderly to public health emergencies in daily state.

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In order to collect data on behaviours of the elderly under their natural state to exclude 132 the effect of epidemic control, the samples of patients interviewed in this paper were limited to 133 those diagnosed before 6th Feb., 2020. When Wuhan closed on 23rd Jan., Wuhan residents 134 realized the seriousness of the epidemic, and their living behaviours were then constrained 135 accordingly. Due to the 14-day average incubation period of the virus before the onset of the 136 disease, it could be roughly assumed that people who were diagnosed before 6th Feb. were        (Table. 1).

Logistic regression results of shopping behaviour 265
The result of logistic regression analysis shows that the model Omnibus Test result was 266 0.001, and the overall percentage of prediction was 76.4%, with a high confidence level. Table   267 4 shows the regression results.

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The frequency of shopping at convenience stores, food markets, the degree of congestion 269 in supermarkets, and the level of protection negatively correlated to illness is significant. With

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The elderly were more likely to use semi-public transport and less likely to use private 300 transport, because they lacked driving skills and preferred to walk leisurely. Compared with 301 private transportation, semi-public transportation was a direct cause of the increased risk of 302 the disease, because of the high degree of exposure, which also showed that the choice of 303 transportation did have an impact on the disease risk.   Table 5 shows that the model Omnibus Test result is 0.018 and the overall percentage of 308 prediction is 69.4%, which shows that the reliability of research results was high. The results of 309 the regression analysis are as follows. According to the data in the table, the walking mode is highly significant.

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In the aspect of shopping of the elderly, in order to reduce the frequency of offline 403 shopping during the epidemic, the online shopping ability of the elderly should be improved.

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The unified purchase and distribution of daily necessities should be done well during the 405 epidemic period. During the non-epidemic period, a shopping platform for the elderly should 406 be developed. The government should enhance community O2O construction, which makes 407 online and offline services to complement each other.

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In the aspect of transportation of the elderly, the ability of the elderly to travel by net-409 booked car should be enhanced on the premise of ensuring the safety of the elderly. Public 410 transport should also be strictly controlled and uniformly deployed during the epidemic 411 period.

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The maintenance of social responsibility and mental health of the elderly should be

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The respondents' basic information was strictly protected. The study did not have any adverse 428 effects on the respondents. Therefore, ethical approval is not required for this study by Office