Clinical Risk, Sociodemographic Factors, and SARS-CoV-2 Infection Over Time in Ontario, Canada
Authors: Udell Jacob A. , Behrouzi Bahar , Sivaswamy Atul , Chu Anna , Ferreira-Legere Laura E. , Fang Jiming , Goodman Shaun G. , Ezekowitz Justin A. , Bainey Kevin R. , van Diepen Sean , Kaul Padma , McAlister Finlay A. , Bogoch Isaac I. , Jackevicius Cynthia , Abdel-Qadir Husam , Wijeysundera Harindra C. , Ko Dennis T. , Austin Peter C. , Lee Douglas S. 
Published: April 2021

AbstractBackgroundSociodemographic and clinical factors are emerging as important predictors for developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.ObjectiveTo determine whether public health interventions that culminated in a stay-at-home lockdown instituted during the first wave of the pandemic in March/April 2020 were effective at mitigating the association of any of these factors with the risk of infection.DesignPopulation-based cohort studySettingOntario, CanadaPatientsAll adults that underwent testing for SARS-CoV-2 between January 1 and June 12, 2020.MeasurementsThe outcome of interest was SARS-CoV-2 infection, determined by reverse transcription polymerase chain reaction testing. Adjusted odds ratios (ORs) were determined for sociodemographic and clinical risk factors before and after the peak of the pandemic to assess for changes in effect sizes.ResultsAmong 578,263 community-dwelling individuals, 20,524 (3.5%) people tested positive. The association between age and SARS-CoV-2 infection risk among tested community-dwelling individuals varied over time (P-interaction <0.0001). Prior to the first-wave peak of the pandemic, the likelihood of SARS-CoV-2 infection increased progressively with age compared with individuals aged 18-45 years (P<0.0001). This association subsequently reversed, with all age groups younger than 85 years at progressively higher risk of infection (P<0.0001) after the peak. Otherwise, risk factors that persisted throughout included male sex, residing in lower income neighborhoods, residing in more racially/ethnically diverse communities, immigration to Canada, and history of hypertension and diabetes. While there was a reduction in infection rates across Ontario after mid-April, there was less impact in regions with higher degrees of racial/ethnic diversity. When considered in an additive risk model, following the initial peak of the pandemic, individuals living in the most racially/ethnically diverse communities with 2, 3, or ≥4 risk factors had ORs of 1.89, 3.07, and 4.73-fold higher for SARS-CoV-2 infection compared to lower risk individuals in their community (all P<0.0001). In contrast, in the least racially/ethnically diverse communities, there was little to no gradient in infection rates across risk strata.ConclusionAfter public health interventions in March/April 2020, people with multiple risk factors residing in the most racially diverse communities of Ontario continued to have the highest likelihood of SARS-CoV-2 infection while risk was mitigated for people with multiple risk factors residing in less racially/ethnically diverse communities. Further efforts are necessary to reduce the risk of SARS-CoV-2 infection among the highest risk individuals residing in these communities.Primary Funding SourceCanadian Institutes of Health Research and the Ted Rogers Centre for Heart Research.