Clinical and Demographic Factors Associated With COVID-19, Severe COVID-19, and SARS-CoV-2 Infection in Adults
Authors: Theodore Deborah A. , Branche Angela R. , Zhang Lily , Graciaa Daniel S. , Choudhary Madhu , Hatlen Timothy J. , Osman Raadhiya , Babu Tara M. , Robinson Samuel T. , Gilbert Peter B. , Follmann Dean , Janes Holly , Kublin James G. , Baden Lindsey R. , Goepfert Paul , Gray Glenda E. , Grinsztejn Beatriz , Kotloff Karen L. , Gay Cynthia L. , Leav Brett , Miller Jacqueline , Hirsch Ian , Sadoff Jerald , Dunkle Lisa M. , Neuzil Kathleen M. , Corey Lawrence , Falsey Ann R. , El Sahly Hana M. , Sobieszczyk Magdalena E. , Huang Yunda ,   COVID-19 Prevention Network (CoVPN), Adams Atoya , Miller Eric , Rankin Bruce G. , Shinn Steven , Nash Marshall , Green Sinikka L. , Jacobsen Colleen , Krishnankutty Jayasree , Phungwayo Sikhongi , Glover Richard M. , Slechta Stacy , Holdeman Troy , Hartvickson Robyn , Grant Amber , Poling Terry L. , Klein Terry D. , Klein Thomas C. , Klein Tracy R. , Smith William B. , Gibson Richard L. , Winbigler Jennifer , Parker Elizabeth , Wijewardane Priyantha N. , Bravo Eric , Thessing Jeffrey , Maxwell Michelle , Horn Amanda , Mary Healy Catherine , Akamine Christine , Chu Laurence , Chouteau R. Michelle , Cotugno Michael J. , Bauer George H. , Hachigian Greg , Oshita Masaru , Cancilla Michael , Kiersey Kristen , Seger William , Antwi Mohammed , Green Allison , Kim Anthony , Desjardins Michael , Johnson Jennifer A. , Sherman Amy , Walsh Stephen R. , Borger Judith , Saleem Nafisa , Solis Joel , Carmen Medina Martha , Keating Westly , Garcia Edgar , Bueno Cynthia , Segall Nathan , Denham Douglas S. , Weiss Thomas , Avworo Ayoade , Hedges Parke , Becher Strout Cynthia , Santiago Rica , Davis Yvonne , Howenstine Patty , Bondell Alison , Marks Kristin , Wang Tina , Wilkin Timothy , Vogler Mary , Johnston Carrie , Andrasik Michele P. , Andriesen Jessica G. , Broder Gail , Eaton Niles , Gelderblom Huub G. , McClennen Rachael , Michael Nelson , Robb Merlin , Sopher Carrie , Miller Vicki E. , Santiago Fredric , Gomez Blanca , Valika Insiya , Starr Amy , Cantos Valeria D. , Kandiah Sheetal , del Rio Carlos , Rouphael Nadine , Edupuganti Srilatha , Anderson Evan J. , Camacho-Gonzalez Andres , Kamidani Satoshi , Rostad Christiana A. , Teherani Meghan , Diemert David J. , Malkin Elissa , Siegel Marc , Roberts Afsoon , Simon Gary , Balani Bindu , Stephenson Carolene , Sperber Steven , Cicogna Cristina , Zervos Marcus J. , Kilgore Paul , Ramesh Mayur , Herc Erica , Zenlea Kate , Burgher Abram , Milliken Ann M. , Davis Joseph D. , Levy Brendan , Kelman Sandra , Doust Matthew W. , Sample Denise , Erickson Sandra , Christensen Shane G. , Matich Christopher , Longe James , Witbeck John , Peterson James T. , Clark Alexander , Kelty Gerald , Pena-Renteria Issac , Koren Michael J. , Bartilucci Darlene , Patel Alpa , Tran Carolyn , Kennelly Christina , Brownlee Robert , Coleman Jacob , Webster Hala , Fierro Carlos A. , Leistner Natalia , Thompson Amy , Gonzalez Celia , Jackson Lisa A , Suyehira Janice , Haber Milton , Regalado Maria M. , Procasky Veronica , Lutat Alisha , Griffin Carl P. , Hollister Ripley R. , Brown Jeremy , Ronk Melody , Harper Wayne L. , Cohen Lisa , Eckert Lynn , Hong Matthew , Rouhbakhsh Rambod , Danford Elizabeth , Johnson John , Calderone Richard , Khetan Shishir K. , Olanrewaju Oyebisi , Zhai Nan , Nieves Kimberly , O'Brien Allison , Bradley Paul S , Lilienthal Amanda , Callis Jim , Brosz Adam B , Clement Andrea , West Whitney , Friesen Luke , Cramer Paul , Eder Frank S , Little Ryan , Engler Victoria , Rattenbury-Shaw Heather , Ensz David J. , Oplinger Allie , Essink Brandon J. , Meyer Jay , Raiser Frederick , Mueller Kimberly , Vrbicky Keith W. , Harper Charles , Nutsch Chelsie , Lewis Wendell , Laflan Cathy , Whatley Jordan L. , Harrell Nicole , Shannon Amie , Rowell Crystal , Dedon Christopher , Makhene Mamodikoe , Gottschlich Gregory M. , Harden Kate , Gottschlich Melissa , Smith Mary , Powell Richard , Kimmel Murray A. , Pinto Simmy , Vachris Timothy P. , Hutchens Mark , Daniels Stephen , Wells Margaret , Van Der Leden Mimi , Jackson-Booth Peta-Gay , Baron Mira , Kane Pamela , Seversen Shannen , Kryvicky Mara , Lord Julia , Saleh Jamshid , Miles Matthew , Lupercio Rafael , McGettigan John W. , Patton Walter , Brakema Riemke , Choquette Karin , McGettigan Jonlyn , Kirstein Judith L. , Bernard Marcia , Manning Mary Beth , Rothenberg Joan , Briskin Toby , Roadman Denise , Tedder-Edwards Sharita , Schwartz Howard I. , Mederos Surisday , Swaminathan Shobha , Nyaku Amesika , Varughese Tilly , DallaPiazza Michelle , Frey Sharon E. , Graham Irene , Abate Getahun , Hoft Daniel , Allen Leland N. , Edwards Leslie A. , Davis William S. , Mena Jessica M. , Kutner Mark E. , Caso Jorge , Hernandez Moran Maria , Carvajal Marianela , Mendez Janet , Wadsworth Larkin T. , Adams Michael R. , Iverson Leslie , Newberg Joseph L. , Pearlman Laura , Nugent Paul J. , Reynolds Michele D. , Bashour Jennifer , Schmidt Robert , Sheth Neil P. , Steil Kenneth , Toma Ramy J. , Kirby William , Folmar Pink , Williams Samantha , Pickrell Paul , Mott Stefanie , Linebarger Carol Ann , Malbari Hussain , Pampe David , Fragoso Veronica G. , Holloway Lisa , McKeown-Bragas Cecilia , Becker Teresa , Williams Barton G. , Jones William H. , Clark Jesse L. , Shoptaw Steven , Vertucci Michele , Hernandez Will , Spector Stephen A. , Moodley Amaran , Blumenthal Jill , Stangl Lisa , Deutsch Karen , Mullane Kathleen M. , Pitrak David , Nuss Cheryl , Pi Judy , Fichtenbaum Carl , Powers-Fletcher Margaret , Saemann Michelle , Kohrs Sharon , Campbell Thomas B. , Lauria Andrew , Mancilla Jose C. , Dunlevy Hillary , Novak Richard M. , Wendrow Andrea , Borgetti Scott , Ladner Ben , Laurens Matthew , Chrisley Lisa , Young Cheryl , Doblecki-Lewis Susanne , Alcaide Maria L. , Gonzales-Zamora Jose , Morris Stephen , Wohl David , Eron Joseph , Frank Ian , Dunbar Debora , Metzger David , Momplaisir Florence , Martin Judith , Hoberman Alejandro , Shope Timothy , Muniz Gysella , Rupp Richard , Stanford Amber , Berman Megan , Porterfield Laura , Lewis Michael , Ghadishah Elham , Yusin Joseph , Pham Mai , Creech Clarence B. , Walker Shannon , Rolsma Stephanie , Samuels Robert , Thomsen Isaac , Kalams Spyros A. , Wilson Greg , Lucksinger Gregg H. , Parks Kevin , Israelsen Ryan , Ostovar Jaleh , Kelly Kary , Overcash Jeffrey S. , Chu Hanh , Lee Kia , De La Cruz Luis I. , Clemons Steve , Everette Elizabeth , Studdard Suzanna , Mohan Gowdhami , Tyson Stefanie , Peay Alyssa-Kay , Johnson Danyel , Feldman Gregory J. , Suen May-Yin , Muenzner Jacqueline , Boscia Joseph , Siddiqui Farhan , Sanders John , Peacock James , Nasim Julio , Levin Michael L. , Hussey Julie , Kulic Marcy , McKenzie Mark M. , Deese Teresa , Osmundsen Erica , Sweet Christy , Ebuh Valentine M. , Elnagar Elwaleed , Ebuh Georgette , Iwuala Genevieve , Han-Conrad Laurie J. , Simmons Todd , Tarakjian Denis , Ackermann Jeremy , Adams Mark S. , Alemán José O. , Al-Ibrahim Mohamed S. , Andes David R. , Andrews Jeb , Arduino Roberto C. , Bäcker Martín , Badillo Diana , Bainbridge Emma , Batteiger Teresa A. , Bazan Jose A. , Bedimo Roger J. , Benitez Jorge A. , Bennett Annette R. , Bernstein David I. , Bialobok Kristin , Boas Rebecca , Brady Judith , Brown Cynthia , Bunce Catherine A. , Call Robert S. , Campbell Wesley , Carmody Ellie , Carpenter Christopher , Carsons Steven E. , Castellon Marvin , Castro Mario , Catan Hannah , Chang Jennifer , Chebib Mouna G. , Chen Corey M. , Cheng Margaret , Chow Brian D. W. , Ciambruschini Annie , Connor Joseph P. , Conway James H. , Cooney Maureen , Curlin Marcel , De La Matta Rodriguez Claudia , Dedon Jon F. , Degan Emily , Dickey Michelle , Dietz Craig , Dong Jennifer L , Dorcely Brenda , Dube Michael P. , Dyer Carmel B. , Eckhardt Benjamin , Ellerbeck Edward , Ewers Evan C. , Falk Amy , Feijoo Brittany , Felsen Uriel R. , Fiel Tom , Fitz-Patrick David , Fogarty Charles M. , Ford Stacy , Forero Lina M. , Formentini Elizabeth , Franco-Vitteri Doris , Frenck Robert W. , Gharib Elie , Gharib Suzanne , Rucker Rola G. , Goldenberg James N. , González Luis H. , Gray Brett , Greene Rusty , Grossberg Robert M. , Guanira-Carranza Juan V. , Gilberto Guerreros Benavides Alfredo , Guillory Clint C. , Gunaratne Shauna H. , Halpert David , Hamilton Holli , Hartman William R. , Henderson Sheryl L. , Herati Ramin , Hernandez Guarin Laura , Hilder Robin , Ho Ken , Hojat Leila , Hosek Sybil G. , Jacobson Jeffrey M. , Jay Melanie , Johnson Diane H. , Jones Kathleen S. , Jones-López Edward C. , Justman Jessica E. , Kahney Scott , Katz Lois , Katz Melinda , Kaul Daniel , Keefer Michael C. , Kennedy Ashley , Knishinsky Jennifer , Kogelman Laura , Koletar Susan L. , Kottkamp Angelica , Laguio-Vila Maryrose , Landovitz Raphael J. , Lee Jessica L. , Liu Albert , Giuvanela Llerena Zegarra Eneyda , Lok Anna S. , Lovell James , Lubelchek Ronald , Lucaj John , Luckasen Gary , Luetkemeyer Annie , Lucia Lugogo Njira , Maenza Janine , Malvestutto Carlos , Mauri Monica , Maves Ryan C. , Mayer Kenneth H. , McCartney Michael J. , McCort Margaret E. , McElrath M. Juliana , McNairy Meredith , Merino Fernando L. , Meyerowitz Eric A. , Mitchell Carol L. , Monaco Cynthia L. , Muhammad Sauda , Muñoz-Gómez Sigridh , Munsiff Sonal , Nee Paul , Nollen Nicole L. , Noor Asif , Nuñez Lagos Claudio , Okulicz Jason F. , Oliver Patrick A. , Ortega Jessica , Palmer Steven , Parameswaran Lalitha , Parikh Purvi , Parker Susan , Parungao Reza , Pavie Juana R. , Madan Rebecca P. , Peralta Henry , Petts Jennifer , Pierce Kristen K. , Pretell Alva E. Javier , Purpura Lawrence J. , Raabe Vanessa , Recuenco Sergio E. , Richards Tamara , Riddler Sharon A. , Rizzardi Barbara , Rokser Rachel , Rolle Charlotte-Paige , Rosen Adam , Rosen Jeffrey , Freese Lena R. , Santolaya María E. , Schipani Linda M. , Schwartz Adam , Schwasinger-Schmidt Tiffany , Scott Hyman , Sha Beverly E. , Shankaran Shivanjali , Shapiro Adrienne E. , Sharp Stephan C. , Shopsin Bo , Sims Matthew D. , Skipper Stephanie , Smith Derek M. , Smith Michael J. , Sobhanie M. Mahdee , Sovic Brit , Sterling Stephanie , Striker Robert , Tafur Bances Karla Beatriz , Talaat Kawsar R. , Tavel Edward M. , Tieu Hong V , Tomaszewski Christian , Tomlinson Ryan , Torres Juan P. , Torres Julian A. , Treanor John J , Tukuru Sade , Ulrich Robert J. , Utz Gregory C. , Viar Veronica , Viau Colindres Roberto A. , Walsh Edward E. , Walsh Mary C. , Walter Emmanuel B. , Weidler Jessica L. , Wu Yi H. , Yang Kinara S. , Yrivarren Giorza Juan Luis , Zemanek Arthur L. , Zhang Kevin , Zingman Barry S. , Gorman Richard , Paez Carmen A. , Swann Edith , Takuva Simbarashe G. , Greninger Alex , Roychoudhury Pavitra , Coombs Robert W. , Jerome Keith R. , Castellino Flora , Tong Xiaomi , Pavetto Corrina , Gipson Teletha , Tong Tina , Lee Marina , Zhou James , Fay Michael , McQuarrie Kelly , Nnadi Chimeremma , Sogbetun Obiageli , Ahmad Nina , De Proost Ian , Hoseyni Cyrus , Coplan Paul , Khan Najat , Ronco Peter , Furey Dawn , Meck Jodi , Vingerhoets Johan , Brandenburg Boerries , Custers Jerome , Hendriks Jenny , Juraszek Jarek , de Groot Anne Marit , Van Roey Griet , Heerwegh Dirk , Van Dromme Ilse , Méndez Galván Jorge F. , Carrascal Monica B. , Sordo Duran Adriana , Sanchez Guerrero Laura Ruy , Gómora Madrid Martha Cecilia , Barrat Hernández Alejandro Quintín , Molina Guizar Sharzhaad , González Estrada Denisse Alejandra , Martínez Pérez Silvano Omar , Zárate Hinojosa Zindy Yazmín , Ruiz-Palacios Guillermo Miguel , Cruz-Valdez Aurelio , Pacheco-Flores Janeth , Lara Anyela , Díaz-Miralrio Secia , Reyes Fentanes María José , Olmos Vega Jocelyn Zuleica , Pineda Méndez Daniela , Cano Martínez Karina , Alvarez León Winniberg Stephany , Ruiz Herrera Vida Veronica , Vázquez Saldaña Eduardo Gabriel , Camacho Choza Laura Julia , Vega Orozco Karen Sofia , Ortega Domínguez Sandra Janeth , Chacón Jorge A. , Rivera Juan J. , Cutz Erika A. , Ortegón Maricruz E. , Rivera María I. , Browder David , Burch Cortney , Moye Terri , Bondy Paul , Browder Lesley , Manning Rickey D. , Hurst James W. , Sturgeon Rodney E. , Wakefield Paul H. , Kirby John A. , Andersen James , Fearon Szheckera , Negron Rosa , Medina Amy , Hill John M. , Rajasekhar Vivek , Williams Hayes , Cade LaShondra , Fouts Rhodna , Moya Connie , Anderson Corey G. , Devine Naomi , Ramsey James , Perez Ashley , Tatelbaum David , Jacobs Michael , Menasche Kathleen , Mirkil Vincent , Winkle Peter J. , Haggag Amina Z. , Haynes Michelle , Villegas Marysol , Raja Sabina , Riesenberg Robert , Plavin Stanford , Lerman Mark , Woodside Leana , Johnson Maria , Healy C. Mary , Whitaker Jennifer A. , Keitel Wendy A. , Atmar Robert L. , Horwith Gary , Mason Robin , Johnson Lisa , Dora Tambra , Murray Deborah , Ledbetter Logan , Ewing Beverly , Stephenson Kathryn E. , Tan Chen S. , Zash Rebecca , Ansel Jessica L. , Jaegle Kate , Guiney Caitlin J. , Henderson Jeffrey A. , O'Leary Marcia , Enright Kendra , Kessler Jill , Ducheneaux Pete , Inniss Asha , Brandon Donald M. , Davis William B. , Lawler Daniel T. , Oppong Yaa D. , Starr Ryan P. , Syndergaard Scott N. , Shelly Rozeli , Islam Majumder Mashrur , Sugimoto Danny , Dugas Jeffrey , Rijos Dolores , Shelton Sandra , Hong Stephan , Schwartz Howard , Sanchez-Crespo Nelia , Schwartz Jennifer , Piedra Terry , Corral Barbara , Medina Carmen , Dever Michael E. , Shah Mitul , Delgado Michael , Scott Tameika , Usdan Lisa S. , McGill Lora J. , Arnold Valerie K. , Scatamacchia Carolyn , Anthony Codi M. , Merchant Rajan , Yoon Anelgine C. , Hill Janet , Ng-Price Lucy , Thompson-Seim Teri , Ackerman Ronald , Ackerman Jamie , Aristy Florida , Ketter Nzeera , Finley Jon , Stull Mildred , Murray Monica , Rizvi Zainab , Guerrero Sonia , Paliwal Yogesh K. , Paliwal Amit , Gordon Sarah , Gordon Bryan , Montano-Pereira Cynthia , Galloway Christopher , Montros Candice , Aleman Lily , Shairi Samira , Van Ever Wesley , Freeman George H. , Harmon Esther L. , Cross Marshall A. , Sales Kacie , Gular Catherine Q. , Hepburn Matthew , Alderson Nathan , Harshell Shana , Mahgoub Siham , Maxwell Celia , Mellman Thomas , Thompson Karl M. , Wortman Glenn , Kingsley Jeff , Pixler April , Curry LaKondria , Afework Sarah , Swanson Austin , Jacqmein Jeffry , Bowers Maggie , Robison Dawn , Mosteller Victoria , Garvey Janet , Easley Mary , Kurnat Rebecca J. , Cornelison Raymond , Gower Shanda , Schnitz William , Heinzig-Cartwright Destiny S. , Lewis Derek , Newton Fred E. , Duhart Aeiress , Watkins Breanz , Ball Brandy , York Jill , Pickle Shelby , Musante David B. , Silver William P. , Belhorn Linda R. , Viens Nicholas A. , Dellaero David , Patel Priti , Lisec Kendra , Safirstein Beth , Zapata Luz , Gonzalez Lazaro , Quevedo Evelyn , Irani Farah , Grillo Joseph , Potts Amy , White Julie , Flume Patrick , Headden Gary , Taylor Brandie , Warden Ashley , Chamberlain Amy , Jeanfreau Robert , Jeanfreau Susan , Matherne Paul G. , Caldwell Amy , Stahl Jessica , Vowell Mandy , Newhouse Lauren , Berthaud Vladimir , Takizala Zudi-Mwak , Beninati Genevieve , Snell Kimberly , Baker Sherrie , Walker James , Harrison Tavane , Miller Meagan , Otto Janet , Gray Roni , Wilson Christine , Nemecek Tiffany , Harrington Hannah , Eppenbach Sally , Lewis Wendell , Bourgeois Tana , Folsom Lyndsea , Holt Gregory , Mirsaeidi Mehdi , Calderon Rafael , Lichtenberger Paola , Quintero Jalima , Martinez Becky , Immergluck Lilly , Johnson Erica , Chan Austin , Fas Norberto , Thomas-Seaton LaTeshia , Khizer Saadia , Staben Jonathan , Beresnev Tatiana , Jahromi Maryam , Marovich Mary A. , Hutter Julia , Nason Martha , Ledgerwood Julie , Mascola John , Leibowitz Mark , Morales Fernanda , Delgado Mike , Sanchez Rosario , Vega Norma , Áñez Germán , Albert Gary , Coston Erin , Desai Chinar , Dunbar Haoua , Eickhoff Mark , Garcia Jenina , Kautz Margaret , Lee Angela , Lewis Maggie , McGarry Alice , McKnight Irene , Nelson Joy , Newingham Patrick , Price-Abbott Patty , Reed Patty , Vegas Diana , Wilkinson Bethanie , Smith Katherine , Woo Wayne , Cho Iksung , Glenn Gregory M. , Dubovsky Filip , Fried David L. , Haughey Lynne A. , Stanton Ariana C. , Stevens Rameaka Lisa , Rosenberg David , Tomatsu Lee , Gonzalez Viviana , Manalo Millie , Grunstra Bernard , Quinn Donald , Claybrook Phillip , Olds Shelby , Dye Amy , Cannon Kevin D. , Chadwick Mesha M. , Jordan Bailey , Hussey Morgan , Nevarez Hannah , Kelley Colleen F. , Chung Michael , Moran Caitlin , Rebolledo Paulina , Bacher Christina , Barranco-Santana Elizabeth , Rodriguez Jessica , Mendoza Rafael , Ruperto Karen , Olivieri Odette , Ocaña Enrique , Wylie Paul E. , Henderson Renea , Jenson Natasa , Yang Fan , Kelley Amy , Finkelstein Kenneth , Beckmann David , Hutchins Tanya , Garcia Escallon Sebastian , Johnson Kristen , Sligh Teresa S. , Desai Parul , Huynh Vincent , Lopez Carlos , Mendoza Erika , Adelglass Jeffrey , Naifeh Jerome G. , Kucera Kristine J. , Chughtai Waseem , Jaffer Shireen H. , Davis Matthew G. , Foley Jennifer , Burgett Michelle L. , Shlotzhauer Tammi L. , Ingalsbe-Geno Sarah M. , Duncanson Daniel , Kush Kelly , Nesbitt Lori , Sonnier Cora , McCarter Jennifer , Butcher Michael B. , Fry James , Percy Donna , Freudemann Karen , Gebhardt Bruce C. , Mangu Padma N. , Schroeck Debra B. , Davit Rajesh K. , Hennekes Gayle D. , Luft Benjamin J. , Carr Melissa , Nachman Sharon , Pellecchia Alison , Smith Candace , Valenti Bruno , Bermudez Maria I. , Peraita Noris , Delgado Ernesto , Arrazcaeta Alicia , Ramirez Natalie , Amador Carmen , Marafioti Horacio , Dang Lyly , Clement Lauren , Berry Jennifer , Allaw Mohammed , Geuss Georgettea , Miles Chelsea , Bittner Zachary , Werne Melody , Calinescu Cornell , Rodman Shannon , Rindt Joshua , Cooksey Erin , Harrison Kristina , Cooper Deanna , Horton Manisha , Philyaw Amanda , Jennings William , Alvarado Hilario , Baka Michele , Regalado Malina , Murray Linda , Naguib Sherif , Singletary Justin , Richmond Sha-Wanda , Omodele Sarah , Oppenheim Emily , Martinez Reuben , Andriulis Victoria , Singer Leonard , Blevins Jeanne , Thomas Meagan , Hull Christine , Pereira Isabel , Rivero Gina , Okonya Tracy , Downing Frances , Miller Paulina , Rhee Margaret , Stapleton Katherine , Klein Jeffrey , Hong Rosamond , Swan Suzanne , Wahlin Tami , Bennett Elizabeth , Salzl Amy , Phan Sharine , White Jewel J. , Occhino Amanda , Paiano Ruth , McLaughlin Morgan , Swieboda Elisa , Garcia-Fragoso Veronica , Becerra Maria G. , White Toni , Turley Christine B. , McWilliams Andrew , Esinhart Tiffany , Montoya Natasha , Huskey Shamika , Paul Leena , Tashima Karen , Johnson Jennie , Neill Marguerite , Sanchez Martha , Rybak Natasha , Mileno Maria , Cohen Stuart H. , Ruiz Monica , Boswell Dean M. , Robison Elizabeth E. , Reynolds Trina L. , Neumeister Sonja , Zorrilla Carmen D. , Rivera Juana , Ibarra Jessica , García Iris , Sierra Dianca , Ramon Wanda , Fiorillo Suzanne , Pitotti Rebecca , Anderson Victoria R. , Castillo Mancilla Jose , Le Nga , Winokur Patricia L. , Ince Dilek , Hegmann Theresa , Meier Jeffrey , Stapleton Jack , Stulken Laura , McArthur Monica , Berry Andrea , Tapia Milagritos , Hammershaimb Elizabeth , Robinson Toni , MacBryde Rosa , Kline Susan , Billings Joanne L. , Cavert Winston , Forgosh Les B. , Schacker Timothy W. , Bold Tyler D. , Dandachi Dima , Nelson Taylor , Bran Andres , Geiger Grant , Naqvi S. Hasan , Florescu Diana F. , Starlin Richard , Kline David , Zimmer Andrea , Abbas Anum , Wilson Natasha , Eron Joseph J. , Sciaudone Michael , Rosengren A. Lina , Kizer John S. , Rutstein Sarah E. , Rodriguez Carina A. , Bruce Elizabeth , Espinosa Claudia , Sanders Lisa J. , Kim Kami , Casey Denise , Taylor Barbara S. , Patterson Thomas , Pinilla Ruth S. , Bullock Delia , Ponce Philip , Patterson Jan , McClelland R. Scott , Lane Dakotah C. , Wald Anna , James Frank , Duke Elizabeth , Hauge Kirsten , Heimonen Jessica , Goecker Erin A. , Huang Yunda , Fong Youyi , Kauffman Carol , Linder Kathleen , Nofz Kimberly , McConnell Andrew , Buynak Robert J. , Webb Angella , Petty Taryn , Andree Stephanie , Sanchez Erica , Mackey Nolan , Baudelaire Clarisse , Dzigiel Sarah , Marquez Adrienna , Quillin Kim , King Michelle , Abad Vanessa , Knowles Jennifer , Waters Michael , Zepeda Karla , Coslet Jordan , Tovar Dalia , Shaw Marian E. , Turner Mark A. , Huffine Cory J. , Huffine Esther S. , Ake Julie A. , Secord Elizabeth , McGrath Eric , Levy Phillip , Stewart Brittany , Cromer Charnell , Walters Ayanna , Ellsworth Grant , Greene Caroline , Galloway Sarah , Kapadia Shashi , DeHaan Elliot , Wilson Clint , Milligan Jason , Raley Danielle , Bocchini Joseph , McClenathan Bruce , Hussain Mary , Lomasney Evelyn , Hall Evelyn , Lamberth Sherry , Schmeck Christy , Leathers Vickie 
Published: July 2023

Importance

Current data identifying COVID-19 risk factors lack standardized outcomes and insufficiently control for confounders.

Objective

To identify risk factors associated with COVID-19, severe COVID-19, and SARS-CoV-2 infection.

Design, Setting, and Participants

This secondary cross-protocol analysis included 4 multicenter, international, randomized, blinded, placebo-controlled, COVID-19 vaccine efficacy trials with harmonized protocols established by the COVID-19 Prevention Network. Individual-level data from participants randomized to receive placebo within each trial were combined and analyzed. Enrollment began July 2020 and the last data cutoff was in July 2021. Participants included adults in stable health, at risk for SARS-CoV-2, and assigned to the placebo group within each vaccine trial. Data were analyzed from April 2022 to February 2023.

Exposures

Comorbid conditions, demographic factors, and SARS-CoV-2 exposure risk at the time of enrollment.

Main Outcomes and Measures

Coprimary outcomes were COVID-19 and severe COVID-19. Multivariate Cox proportional regression models estimated adjusted hazard ratios (aHRs) and 95% CIs for baseline covariates, accounting for trial, region, and calendar time. Secondary outcomes included severe COVID-19 among people with COVID-19, subclinical SARS-CoV-2 infection, and SARS-CoV-2 infection.

Results

A total of 57 692 participants (median [range] age, 51 [18-95] years; 11 720 participants [20.3%] aged ≥65 years; 31 058 participants [53.8%] assigned male at birth) were included. The analysis population included 3270 American Indian or Alaska Native participants (5.7%), 7849 Black or African American participants (13.6%), 17 678 Hispanic or Latino participants (30.6%), and 40 745 White participants (70.6%). Annualized incidence was 13.9% (95% CI, 13.3%-14.4%) for COVID-19 and 2.0% (95% CI, 1.8%-2.2%) for severe COVID-19. Factors associated with increased rates of COVID-19 included workplace exposure (high vs low: aHR, 1.35 [95% CI, 1.16-1.58]; medium vs low: aHR, 1.41 [95% CI, 1.21-1.65]; P &amp;lt; .001) and living condition risk (very high vs low risk: aHR, 1.41 [95% CI, 1.21-1.66]; medium vs low risk: aHR, 1.19 [95% CI, 1.08-1.32]; P &amp;lt; .001). Factors associated with decreased rates of COVID-19 included previous SARS-CoV-2 infection (aHR, 0.13 [95% CI, 0.09-0.19]; P &amp;lt; .001), age 65 years or older (aHR vs age &amp;lt;65 years, 0.57 [95% CI, 0.50-0.64]; P &amp;lt; .001) and Black or African American race (aHR vs White race, 0.78 [95% CI, 0.67-0.91]; P = .002). Factors associated with increased rates of severe COVID-19 included race (American Indian or Alaska Native vs White: aHR, 2.61 [95% CI, 1.85-3.69]; multiracial vs White: aHR, 2.19 [95% CI, 1.50-3.20]; P &amp;lt; .001), diabetes (aHR, 1.54 [95% CI, 1.14-2.08]; P = .005) and at least 2 comorbidities (aHR vs none, 1.39 [95% CI, 1.09-1.76]; P = .008). In analyses restricted to participants who contracted COVID-19, increased severe COVID-19 rates were associated with age 65 years or older (aHR vs &amp;lt;65 years, 1.75 [95% CI, 1.32-2.31]; P &amp;lt; .001), race (American Indian or Alaska Native vs White: aHR, 1.98 [95% CI, 1.38-2.83]; Black or African American vs White: aHR, 1.49 [95% CI, 1.03-2.14]; multiracial: aHR, 1.81 [95% CI, 1.21-2.69]; overall P = .001), body mass index (aHR per 1-unit increase, 1.03 [95% CI, 1.01-1.04]; P = .001), and diabetes (aHR, 1.85 [95% CI, 1.37-2.49]; P &amp;lt; .001). Previous SARS-CoV-2 infection was associated with decreased severe COVID-19 rates (aHR, 0.04 [95% CI, 0.01-0.14]; P &amp;lt; .001).

Conclusions and Relevance

In this secondary cross-protocol analysis of 4 randomized clinical trials, exposure and demographic factors had the strongest associations with outcomes; results could inform mitigation strategies for SARS-CoV-2 and viruses with comparable epidemiological characteristics.