At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area.
At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area.
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美国主要大都市地区 SARS-CoV-2 感染的家庭检测和风险因素。
DOI：
10.1101/2022.02.02.22269258
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Cosimi,LisaA
中科院分区：
文献类型：
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作者：
Woolley,AnnE;Dryden-Peterson,Scott;Kim,Andy;Naz-McLean,Sarah;Kelly,Christina;Laibinis,HannahH;Bagnall,Josephine;Livny,Jonathan;Ma,Peijun;Orzechowski,Marek;Shoresh,Noam;Gabriel,Stacey;Hung,DeborahT;Cosimi,LisaA
背景：对与感染严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）相关的风险进行有偏见的评估，对于在大流行期间为缓解工作提供信息至关重要。本研究的目的是了解美国大城市地区成年居民的大型前瞻性队列中感染2019冠状病毒病（COVID-19）的危险因素。方法设计了一项全远程纵向队列研究，包括每月在家进行SARS-CoV-2聚合酶链反应（PCR）、血清学自检和每月调查。在2020年10月至2021年1月期间，我们招募了10289名成年人，反映了波士顿大都市区的人口普查数据。在研究开始时，567名（5.5%）参与者有目前或以前感染SARS-CoV-2的证据。到2021年6月15日，这一比例增加到13.4%。与白人相比，黑人非西班牙裔参与者感染COVID-19的风险高出2.2倍（风险比[HR]， 2.19; 95% CI, 1.91-2.50；P< .001），西班牙裔参与者的风险高出1.5倍（HR, 1.52; 95% CI, 1.32-1.71；P< .016）。年龄在18-29岁之间的人，在外工作的人，以及与其他成年人和儿童住在一起的人的风险增加。第二和第三低贫困社区的个人与感染COVID-19的风险增加有关。具有重症医学危险因素的个体感染SARS-CoV-2的风险降低。结论种族/民族和社会经济地位是感染的最大决定因素。如果仅基于PCR数据，这种差异被严重低估了，正如非白人参与者的血清学与PCR检测的差异所指出的那样，并且指出了在获得检测方面的持续差异。医疗状况和高龄增加了SARS-CoV-2疾病严重程度的风险，与较低的COVID-19感染风险相关，这表明行为改变的重要性。这些发现突出表明，需要制定缓解方案，克服当前和未来流行病中结构性种族主义的挑战。
BackgroundUnbiased assessment of the risks associated with acquisition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical to informing mitigation efforts during pandemics. The objective of our study was to understand the risk factors for acquiring coronavirus disease 2019 (COVID-19) in a large prospective cohort of adult residents in a large US metropolitan area.MethodsWe designed a fully remote longitudinal cohort study involving monthly at-home SARS-CoV-2 polymerase chain reaction (PCR) and serology self-testing and monthly surveys.ResultsBetween October 2020 and January 2021, we enrolled 10 289 adults reflective of the Boston metropolitan area 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 with Whites, Black non-Hispanic participants had a 2.2-fold greater risk of acquiring COVID-19 (hazard ratio [HR], 2.19; 95% CI, 1.91–2.50;P< .001), and Hispanics had a 1.5-fold greater risk (HR, 1.52; 95% CI, 1.32–1.71;P< .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 were associated with an increased risk of acquiring COVID-19. Individuals with medical risk factors for severe disease were at a decreased risk of SARS-CoV-2 acquisition.ConclusionsThese results demonstrate that race/ethnicity and socioeconomic status are the biggest determinants of acquisition of infection. 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. Medical conditions and advanced age, which increase the risk for severity of SARS-CoV-2 disease, were associated with a lower risk of COVID-19 acquisition, 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.