Risk of severe acute respiratory syndrome coronavirus 2 infection among women with polycystic ovary syndrome

OBJECTIVE: To determine whether women with polycystic ovary syndrome (PCOS) had a higher incidence of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than those without PCOS and evaluate whether PCOS diagnosis independently increased the risk of moderate or severe disease in those with positive SARS-CoV-2 test results. DESIGN: Retrospective cohort study using the National COVID Cohort Collaborative (N3C). SETTING: National COVID Cohort Collaborative. PATIENT(S): Adult nonpregnant women (age, 18–65 years) enrolled in the N3C with confirmed SARS-CoV-2 testing for any indication. Sensitivity analyses were conducted in women aged 18–49 years and who were obese (body mass index, ≥30 kg/m(2)). INTERVENTION(S): The exposure was PCOS as identified by the N3C clinical diagnosis codes and concept sets, which are a compilation of terms, laboratory values, and International Classification of Diseases codes for the diagnosis of PCOS. To further capture patients with the symptoms of PCOS, we also included those who had concept sets for both hirsutism and irregular menses. MAIN OUTCOME MEASURE(S): Odds of testing positive for SARS-CoV-2 and odds of moderate or severe coronavirus disease 2019 (COVID-19) in the PCOS cohort compared with those in the non-PCOS cohort. RESULT(S): Of the 2,089,913 women included in our study, 39,459 had PCOS. In the overall cohort, the adjusted odds ratio (aOR) of SARS-CoV-2 positivity was 0.98 (95% confidence interval [CI], 0.97–0.98) in women with PCOS compared to women without PCOS. The aORs of disease severity were as follows: mild disease, 1.02 (95% CI, 1.01–1.03); moderate disease, 0.99 (95% CI, 0.98–1.00); and severe disease, 0.99 (95% CI, 0.99–1.00). There was no difference in COVID-19–related mortality (aOR, 1.00; 95% CI, 0.99–1.00). These findings were similar in the reproductive-age and obese reproductive-age cohorts. CONCLUSION(S): Women with PCOS had a similar likelihood of testing positive for SARS-CoV-2. Among those who tested positive, they were no more likely to have moderate or severe COVID-19 than the non-PCOS cohort. Polycystic ovary syndrome is a chronic condition associated with several comorbidities, including cardiovascular disease and mental health issues. Although these comorbidities are also associated with COVID-19 morbidity, our findings suggest that the comorbidities themselves, rather than PCOS, drive the risk of disease severity.