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Risk Factors for testing positive for SARS-CoV-2 in a national US healthcare system.
BACKGROUND: Identifying risk factors for SARS-CoV-2 infection could help health systems improve testing and screening strategies.
OBJECTIVES: Identify demographic factors, comorbid conditions, and symptoms independently associated with testing positive for SARS-CoV-2.
DESIGN: Observational cross-sectional study.
SETTING: Veterans Health Administration.
PATIENTS: Persons tested for SARS-CoV-2 nucleic acid by polymerase chain reaction (PCR) between March 1 and May 14, 2020.
MEASUREMENTS: Associations between demographic characteristics, diagnosed comorbid conditions, and documented symptoms with testing positive for SARS-CoV-2.
RESULTS: Of 88,747 persons tested, 10,131 (11.4%) were SARS-CoV-2 PCR positive. Positivity was associated with older age (≥80 vs. <50 years: aOR 2.16, 95% CI 1.97-2.37), male sex (aOR 1.45, 95% CI 1.34-1.57), regional SARS-CoV-2 burden (≥2,000 vs. <400 cases/million: aOR 5.43, 95% CI 4.97-5.93), urban residence (aOR 1.78, 95% CI 1.70-1.87), Black (aOR 2.15, 95% CI 2.05-2.26) or American Indian/Alaska Native/Pacific Islander (aOR 1.26, 95% CI 1.05-1.52) vs. White race, and Hispanic ethnicity (aOR 1.52, 95% CI 1.40-1.65). Obesity and diabetes were the only two medical conditions associated with testing positive. Documented fevers, chills, cough, and diarrhea were also associated with testing positive. The population attributable fraction of positive tests was highest for regional SARS-CoV-2 burden (35.3%), followed by demographic variables (27.2%), symptoms (12.0%), obesity (10.5%), and diabetes (0.4%).
LIMITATIONS: Lack of information on SARS-CoV-2 exposures or the indications for testing which may affect the likelihood of testing positive.
CONCLUSION: The majority of positive SARS-CoV-2 tests were attributed to regional SARS-CoV-2 burden, demographic characteristics and obesity with a minor contribution of chronic comorbid conditions.
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