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At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area

IMPORTANCE: Unbiased assessment of risks associated with acquisition of SARS-CoV-2 is critical to informing mitigation efforts during pandemics. OBJECTIVE: Understand risk factors for acquiring COVID-19 in a large, prospective cohort of adult residents recruited to be representative of a large US me...

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Autores principales: Woolley, Ann E., Dryden-Peterson, Scott, Kim, Andy, Naz-McLean, Sarah, Kelly, Christina, Laibinis, Hannah H., Bagnall, Josephine, Livny, Jonathan, Ma, Peijun, Orzechowski, Marek, Shoresh, Noam, Gabriel, Stacey, Hung, Deborah T., Cosimi, Lisa A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cold Spring Harbor Laboratory 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820677/
https://www.ncbi.nlm.nih.gov/pubmed/35132425
http://dx.doi.org/10.1101/2022.02.02.22269258
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author Woolley, Ann E.
Dryden-Peterson, Scott
Kim, Andy
Naz-McLean, Sarah
Kelly, Christina
Laibinis, Hannah H.
Bagnall, Josephine
Livny, Jonathan
Ma, Peijun
Orzechowski, Marek
Shoresh, Noam
Gabriel, Stacey
Hung, Deborah T.
Cosimi, Lisa A.
author_facet Woolley, Ann E.
Dryden-Peterson, Scott
Kim, Andy
Naz-McLean, Sarah
Kelly, Christina
Laibinis, Hannah H.
Bagnall, Josephine
Livny, Jonathan
Ma, Peijun
Orzechowski, Marek
Shoresh, Noam
Gabriel, Stacey
Hung, Deborah T.
Cosimi, Lisa A.
author_sort Woolley, Ann E.
collection PubMed
description IMPORTANCE: Unbiased assessment of risks associated with acquisition of SARS-CoV-2 is critical to informing mitigation efforts during pandemics. OBJECTIVE: Understand risk factors for acquiring COVID-19 in a large, prospective cohort of adult residents recruited to be representative of a large US metropolitan area. DESIGN: Fully remote longitudinal cohort study launched in October 2020 and ongoing; Study data reported through June 15, 2021. SETTING: Brigham and Women’s Hospital, Boston MA. PARTICIPANTS: Adults within 45 miles of Boston, MA. INTERVENTION: Monthly at-home SARS-CoV-2 viral and antibody testing. MAIN OUTCOMES: Between October 2020 and January 2021, we enrolled 10,289 adults reflective of Massachusetts census data. At study entry, 567 (5.5%) participants had evidence of current or prior SARS-CoV-2 infection. This increased to 13.4% by June 15, 2021. Compared to whites, Black non-Hispanic participants had a 2.2 fold greater risk of acquiring COVID-19 (HR 2.19, 95% CI 1.91–2.50; p=<0.001) and Hispanics had a 1.5 fold greater risk (HR 1.52, 95% CI 1.32–1.71; p=<0.016). Individuals aged 18–29, those who worked outside the home, and those living with other adults and children were at an increased risk. Individuals in the second and third lowest disadvantaged neighborhood communities, as measured by the area deprivation index as a marker for socioeconomic status by census block group, were associated with an increased risk in developing COVID-19. Individuals with medical risk factors for severe COVID-19 disease were at a decreased risk of SARS-CoV-2 acquisition. CONCLUSIONS: These results demonstrate that race/ethnicity and socioeconomic status are not only risk factors for severity of disease but are also the biggest determinants of acquisition of infection. Importantly, this disparity is significantly underestimated if based on PCR data alone as noted by the discrepancy in serology vs. PCR detection for non-white participants, and points to persistent disparity in access to testing. Meanwhile, medical conditions and advanced age that increase the risk for severity of SARS-CoV-2 disease were associated with a lower risk of acquisition of COVID-19 suggesting the importance of behavior modifications. These findings highlight the need for mitigation programs that overcome challenges of structural racism in current and future pandemics.
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spelling pubmed-88206772022-02-08 At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area Woolley, Ann E. Dryden-Peterson, Scott Kim, Andy Naz-McLean, Sarah Kelly, Christina Laibinis, Hannah H. Bagnall, Josephine Livny, Jonathan Ma, Peijun Orzechowski, Marek Shoresh, Noam Gabriel, Stacey Hung, Deborah T. Cosimi, Lisa A. medRxiv Article IMPORTANCE: Unbiased assessment of risks associated with acquisition of SARS-CoV-2 is critical to informing mitigation efforts during pandemics. OBJECTIVE: Understand risk factors for acquiring COVID-19 in a large, prospective cohort of adult residents recruited to be representative of a large US metropolitan area. DESIGN: Fully remote longitudinal cohort study launched in October 2020 and ongoing; Study data reported through June 15, 2021. SETTING: Brigham and Women’s Hospital, Boston MA. PARTICIPANTS: Adults within 45 miles of Boston, MA. INTERVENTION: Monthly at-home SARS-CoV-2 viral and antibody testing. MAIN OUTCOMES: Between October 2020 and January 2021, we enrolled 10,289 adults reflective of Massachusetts census data. At study entry, 567 (5.5%) participants had evidence of current or prior SARS-CoV-2 infection. This increased to 13.4% by June 15, 2021. Compared to whites, Black non-Hispanic participants had a 2.2 fold greater risk of acquiring COVID-19 (HR 2.19, 95% CI 1.91–2.50; p=<0.001) and Hispanics had a 1.5 fold greater risk (HR 1.52, 95% CI 1.32–1.71; p=<0.016). Individuals aged 18–29, those who worked outside the home, and those living with other adults and children were at an increased risk. Individuals in the second and third lowest disadvantaged neighborhood communities, as measured by the area deprivation index as a marker for socioeconomic status by census block group, were associated with an increased risk in developing COVID-19. Individuals with medical risk factors for severe COVID-19 disease were at a decreased risk of SARS-CoV-2 acquisition. CONCLUSIONS: These results demonstrate that race/ethnicity and socioeconomic status are not only risk factors for severity of disease but are also the biggest determinants of acquisition of infection. Importantly, this disparity is significantly underestimated if based on PCR data alone as noted by the discrepancy in serology vs. PCR detection for non-white participants, and points to persistent disparity in access to testing. Meanwhile, medical conditions and advanced age that increase the risk for severity of SARS-CoV-2 disease were associated with a lower risk of acquisition of COVID-19 suggesting the importance of behavior modifications. These findings highlight the need for mitigation programs that overcome challenges of structural racism in current and future pandemics. Cold Spring Harbor Laboratory 2022-02-03 /pmc/articles/PMC8820677/ /pubmed/35132425 http://dx.doi.org/10.1101/2022.02.02.22269258 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.
spellingShingle Article
Woolley, Ann E.
Dryden-Peterson, Scott
Kim, Andy
Naz-McLean, Sarah
Kelly, Christina
Laibinis, Hannah H.
Bagnall, Josephine
Livny, Jonathan
Ma, Peijun
Orzechowski, Marek
Shoresh, Noam
Gabriel, Stacey
Hung, Deborah T.
Cosimi, Lisa A.
At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area
title At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area
title_full At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area
title_fullStr At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area
title_full_unstemmed At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area
title_short At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area
title_sort at-home testing and risk factors for acquisition of sars-cov-2 infection in a major us metropolitan area
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820677/
https://www.ncbi.nlm.nih.gov/pubmed/35132425
http://dx.doi.org/10.1101/2022.02.02.22269258
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