Veterans Affairs North Texas Health Care System, Dallas, TX, USA.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Sci Rep. 2021 Apr 19;11(1):8497. doi: 10.1038/s41598-021-88111-z.
The burden of COVID-19 has been noted to be disproportionately greater in minority women, a population that is nevertheless still understudied in COVID-19 research. We conducted an observational study to examine COVID-19-associated mortality and cardiovascular disease outcomes after testing (henceforth index) among a racially diverse adult women veteran population. We assembled a retrospective cohort from a Veterans Affairs (VA) national COVID-19 shared data repository, collected between February and August 2020. A case was defined as a woman veteran who tested positive for SARS-COV-2, and a control as a woman veteran who tested negative. We used Kaplan-Meier curves and the Cox proportional hazards model to examine the distribution of time to death and the effects of baseline predictors on mortality risk. We used generalized linear models to examine 60-day cardiovascular disease outcomes. Covariates studied included age, body mass index (BMI), and active smoking status at index, and pre-existing conditions of diabetes, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and a history of treatment with antiplatelet or anti-thrombotic drug at any time in the 2 years prior to the index date. Women veterans who tested positive for SARS-CoV-2 had 4 times higher mortality risk than women veterans who tested negative (Hazard Ratio 3.8, 95% Confidence Interval CI 2.92 to 4.89) but had lower risk of cardiovascular events (Odds Ratio OR 0.78, 95% CI 0.66 to 0.92) and developing new heart disease conditions within 60 days (OR 0.67, 95% CI 0.58 to 0.77). Older age, obesity (BMI > 30), and prior CVD and COPD conditions were positively associated with increased mortality in 60 days. Despite a higher infection rate among minority women veterans, there was no significant race difference in mortality, cardiovascular events, or onset of heart disease. SARS-CoV-2 infection increased short-term mortality risk among women veterans similarly across race groups. However, there was no evidence of increased cardiovascular disease incidence in 60 days. A longer follow-up of women veterans who tested positive is warranted.
COVID-19 对少数族裔女性的影响不成比例地更大，而这一人群在 COVID-19 研究中仍未得到充分研究。我们进行了一项观察性研究，以检查在一个种族多样化的成年女性退伍军人人群中进行测试（以下简称索引）后与 COVID-19 相关的死亡率和心血管疾病结果。我们从退伍军人事务部（VA）的一个 COVID-19 共享数据存储库中组建了一个回顾性队列，收集时间为 2020 年 2 月至 8 月。病例定义为 SARS-COV-2 检测呈阳性的女性退伍军人，对照组为 SARS-COV-2 检测呈阴性的女性退伍军人。我们使用 Kaplan-Meier 曲线和 Cox 比例风险模型来检查死亡时间的分布以及基线预测因素对死亡率风险的影响。我们使用广义线性模型来检查 60 天的心血管疾病结果。研究的协变量包括年龄、体重指数（BMI）以及索引时的主动吸烟状态，以及在索引日期前 2 年内任何时间使用抗血小板或抗血栓药物治疗的糖尿病、慢性肾脏病（CKD）、慢性阻塞性肺疾病（COPD）和既往病史。SARS-CoV-2 检测呈阳性的女性退伍军人的死亡率风险比 SARS-CoV-2 检测呈阴性的女性退伍军人高 4 倍（风险比 3.8，95%置信区间 CI 2.92 至 4.89），但心血管事件风险较低（比值比 OR 0.78，95%置信区间 CI 0.66 至 0.92），并且在 60 天内新发心脏病的风险较低（OR 0.67，95%置信区间 CI 0.58 至 0.77）。年龄较大、肥胖（BMI>30）以及先前的心血管疾病和 COPD 状况与 60 天内死亡率增加呈正相关。尽管少数族裔女性退伍军人的感染率较高，但在死亡率、心血管事件或心脏病发作方面，种族差异并不显著。SARS-CoV-2 感染同样增加了女性退伍军人的短期死亡率风险。然而，在 60 天内没有证据表明心血管疾病发病率增加。需要对 SARS-CoV-2 检测呈阳性的女性退伍军人进行更长时间的随访。
