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Prior diagnoses and medications as risk factors for COVID-19 in a Los Angeles Health System

Chang et al., medRxiv, doi:10.1101/2020.07.03.20145581
Jul 2020  
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Case 43% Improvement Relative Risk Vitamin D for COVID-19  Chang et al.  Sufficiency Are vitamin D levels associated with COVID-19 outcomes? Retrospective study in the USA (March - June 2020) Fewer cases with higher vitamin D levels (p=0.0000057) c19early.org Chang et al., medRxiv, July 2020 Favorsvitamin D Favorscontrol 0 0.5 1 1.5 2+
Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
 
*, now with p < 0.00000000001 from 122 studies, recognized in 9 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19early.org
Retrospective 26,602 individuals tested for SARS-CoV-2 showing increased COVID-19 susceptibility with vitamin D deficiency.
This is the 6th of 199 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 835,162 vigintillion).
risk of case, 43.2% lower, OR 0.57, p < 0.001, cutoff 20ng/mL, inverted to make OR<1 favor high D levels (≥20ng/mL), Table S4, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Chang et al., 4 Jul 2020, retrospective, USA, preprint, 13 authors, study period 9 March, 2020 - 14 June, 2020. Contact: timothychang@mednet.ucla.edu, mbutte@mednet.ucla.edu, bpasaniuc@mednet.ucla.edu.
This PaperVitamin DAll
Prior diagnoses and medications as risk factors for COVID-19 in a Los Angeles Health System
M.D Timothy S Chang, M.S Yi Ding, Ph.D Malika K Freund, Ruth Johnson, Tommer Schwarz, M.D Julie M Yabu, Ph.D Chad Hazlett, Ph.D Jeffrey N Chiang, Ami Wulf, M.D Daniel H Geschwind, M.D Manish J Butte, Ph.D Bogdan Pasaniuc
doi:10.1101/2020.07.03.20145581
With the continuing coronavirus disease 2019 (COVID-19) pandemic coupled with phased reopening, it is critical to identify risk factors associated with susceptibility and severity of disease in a diverse population to help shape government policies, guide clinical decision making, and prioritize future COVID-19 research. In this retrospective case-control study, we used de-identified electronic health records (EHR) from the University of California Los Angeles (UCLA) Health System between March 9 th , 2020 and June 14 th , 2020 to identify risk factors for COVID-19 susceptibility (severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) PCR test positive), inpatient admission, and severe outcomes (treatment in an intensive care unit or intubation). Of the 26,602 individuals tested by PCR for SARS-CoV-2, 992 were COVID-19 positive (3.7% of Tested), 220 were admitted in the hospital (22% of COVID-19 positive), and 77 had a severe outcome (35% of Inpatient). Consistent with previous studies, males and individuals older than 65 years old had increased risk of inpatient admission. Notably, individuals self-identifying as Hispanic or Latino constituted an increasing percentage of COVID-19 patients as disease severity escalated, comprising 24% of those testing positive, but 40% of those with a severe outcome, a disparity that remained after correcting for medical comorbidities. Cardiovascular disease, hypertension, and renal disease were premorbid risk factors present before SARS-CoV-2 PCR testing associated with COVID-19 susceptibility. Less well-established risk factors for COVID-19 susceptibility included pre-existing dementia (odds ratio (OR) 5.2 [3.2-8.3], p=2.6 x 10 -10 ), mental health conditions (depression OR 2.1 [1.6-2.8], p=1.1 x 10 -6 ) and vitamin D deficiency (OR 1.8 [1.4-2.2], p=5.7 x 10 -6 ). Renal diseases including end-stage renal disease and anemia due to chronic renal disease were the predominant premorbid risk factors for COVID-19 inpatient admission. Other less established risk factors for COVID-19 inpatient admission included previous renal transplant (OR 9.7 [2.8-39], p=3.2x10 -4 ) and disorders of the immune system (OR 6.0 [2.3, 16], p=2.7x10 -4 ). Prior use of oral steroid medications was associated with decreased COVID-19 positive testing risk (OR 0.61 [0.45, .
Declaration of Interests The authors declare no competing interests Methods Study design This was an observational case-control study within a cohort of patients registered at the UCLA Health System after January 1, 2013. The UCLA Health System includes two hospitals (520 and 281 inpatient beds) and 210 primary and specialty outpatient locations predominantly located in Los Angeles County. We leveraged an extract of the de-identified EHR from the UCLA Health System known as the UCLA Data Discovery Repository (DDR), developed under the auspices of the UCLA Health Office of Health Informatics Analytics and the UCLA Institute of Precision Health. The DDR contains longitudinal electronic records for more than 1.5 million patients since 2013, including patient demographics, problems, medications, vital signs, past medical history, and laboratory data. This study was considered human subjects research exempt because all electronic health records were de-identified (UCLA IRB# 20-001180). Outcomes and Case/Control Selection From March 9, 2020 to June 14, 2020, 26,602 individuals were tested for SARS-CoV-2 via reverse transcriptase polymerase chain reaction (RT-PCR) within the UCLA Health System. Three different levels of COVID-19 outcome were defined (Figure 1 ). COVID-19 positive cases were those with a positive SARS-CoV-2 PCR test result (COVID-19 positive). To determine individuals with SARS-CoV-2 testing, lab tests in the DDR were searched for "SARS-CoV-2" or..
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Teoria ' 'statistica delle classi e calcolo delle probabilita’.'}], 'container-title': [], 'original-title': [], 'link': [ { 'URL': 'https://syndication.highwire.org/content/doi/10.1101/2020.07.03.20145581', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 11, 1]], 'date-time': '2022-11-01T04:13:19Z', 'timestamp': 1667275999000}, 'score': 1, 'resource': {'primary': {'URL': 'http://medrxiv.org/lookup/doi/10.1101/2020.07.03.20145581'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 7, 4]]}, 'references-count': 83, 'URL': 'http://dx.doi.org/10.1101/2020.07.03.20145581', 'relation': {}, 'subject': [], 'published': {'date-parts': [[2020, 7, 4]]}, 'subtype': 'preprint'}
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