Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
BMJ Open. 2021 Feb 12;11(2):e043584. doi: 10.1136/bmjopen-2020-043584.
We sought to determine the extent of SARS-CoV-2 seroprevalence and the factors associated with seroprevalence across a diverse cohort of healthcare workers.
Observational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionnaires.
A multisite healthcare delivery system located in Los Angeles County.
A diverse and unselected population of adults (n=6062) employed in a multisite healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with non-patient-oriented work functions.
Using Bayesian and multivariate analyses, we estimated seroprevalence and factors associated with seropositivity and antibody levels, including pre-existing demographic and clinical characteristics; potential COVID-19 illness-related exposures; and symptoms consistent with COVID-19 infection.
We observed a seroprevalence rate of 4.1%, with anosmia as the most prominently associated self-reported symptom (OR 11.04, p<0.001) in addition to fever (OR 2.02, p=0.002) and myalgias (OR 1.65, p=0.035). After adjusting for potential confounders, seroprevalence was also associated with Hispanic ethnicity (OR 1.98, p=0.001) and African-American race (OR 2.02, p=0.027) as well as contact with a COVID-19-diagnosed individual in the household (OR 5.73, p<0.001) or clinical work setting (OR 1.76, p=0.002). Importantly, African-American race and Hispanic ethnicity were associated with antibody positivity even after adjusting for personal COVID-19 diagnosis status, suggesting the contribution of unmeasured structural or societal factors.
The demographic factors associated with SARS-CoV-2 seroprevalence among our healthcare workers underscore the importance of exposure sources beyond the workplace. The size and diversity of our study population, combined with robust survey and modelling techniques, provide a vibrant picture of the demographic factors, exposures and symptoms that can identify individuals with susceptibility as well as potential to mount an immune response to COVID-19.
我们旨在确定 SARS-CoV-2 血清流行率的程度，以及与不同人群的医护人员血清流行率相关的因素。
对医护人员进行观察性队列研究，包括 SARS-CoV-2 血清学检测和参与者问卷调查。
位于洛杉矶县的多站点医疗服务系统。
在位于洛杉矶县的多站点医疗服务系统中工作的成年人（n=6062），包括有直接病人接触的人和其他非面向病人的工作职能的人，人群多样且未进行选择。
我们使用贝叶斯和多变量分析，估计了血清流行率和与血清阳性率及抗体水平相关的因素，包括预先存在的人口统计学和临床特征；与 COVID-19 相关的潜在疾病暴露；以及与 COVID-19 感染一致的症状。
我们观察到血清流行率为 4.1%，嗅觉丧失是最突出的自我报告症状（OR 11.04，p<0.001），此外还有发热（OR 2.02，p=0.002）和肌痛（OR 1.65，p=0.035）。在调整潜在混杂因素后，血清流行率还与西班牙裔（OR 1.98，p=0.001）和非裔美国人（OR 2.02，p=0.027）种族以及与家中 COVID-19 确诊患者（OR 5.73，p<0.001）或临床工作环境（OR 1.76，p=0.002）接触有关。重要的是，非裔美国人种族和西班牙裔与抗体阳性有关，即使在调整个人 COVID-19 诊断状态后也是如此，这表明存在未测量的结构性或社会因素的影响。
我们医护人员中与 SARS-CoV-2 血清流行率相关的人口统计学因素强调了工作场所以外的暴露源的重要性。我们的研究人群规模大且多样化，结合了强大的调查和建模技术，生动地描绘了人口统计学因素、暴露和症状，可以识别易感性高的个体以及对 COVID-19 产生免疫反应的潜力。
