Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program
Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program
Abstract Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the contextual and spatial risk factors for PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified contextual and spatial risk factors from nearly 200 environmental characteristics for 23 PASC symptoms and conditions of eight organ systems. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each contextual and spatial factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) contextual and spatial characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), criteria air pollutants (e.g., sulfur dioxide), particulate matter (PM2.5) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, respiratory, blood, circulatory, endocrine, and other organ systems. Specific contextual and spatial risk factors for each PASC condition and symptom were different across New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular contextual and spatial characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.
Hu Hui、Lewis V Colby、Zang Chengxi、Koropsak Michael、Xu Jie、Shenkman Elizabeth A.、Kaushal Rainu、Wei Wei-Qi、Bian Jiang、Xu Zhenxing、Rothman Russell L.、Fokaidis Vasilios、Zhang Yongkang、Carton Thomas W.、Weiner Mark G.、Hall Jaclyn、Wang Fei
Channing Division of Network Medicine, Brigham and Women?ˉs Hospital and Harvard Medical SchoolDepartment of Population Health Sciences, Weill Cornell MedicineDepartment of Population Health Sciences, Weill Cornell MedicineDepartment of Population Health Sciences, Weill Cornell MedicineDepartment of Health Outcomes Biomedical Informatics, University of FloridaDepartment of Health Outcomes Biomedical Informatics, University of FloridaDepartment of Population Health Sciences, Weill Cornell MedicineDepartment of Biomedical Informatics, Vanderbilt University Medical CenterDepartment of Health Outcomes Biomedical Informatics, University of FloridaDepartment of Population Health Sciences, Weill Cornell MedicineDepartment of Pediatrics, Vanderbilt University Medical CenterDepartment of Population Health Sciences, Weill Cornell MedicineDepartment of Population Health Sciences, Weill Cornell MedicineLouisiana Public Health InstituteDepartment of Population Health Sciences, Weill Cornell MedicineDepartment of Health Outcomes Biomedical Informatics, University of FloridaDepartment of Population Health Sciences, Weill Cornell Medicine
医学研究方法环境污染、环境污染防治
SARS-CoV-2 infectionLong-COVIDAir pollutionNeighborhood deprivationBuilt environment
Hu Hui,Lewis V Colby,Zang Chengxi,Koropsak Michael,Xu Jie,Shenkman Elizabeth A.,Kaushal Rainu,Wei Wei-Qi,Bian Jiang,Xu Zhenxing,Rothman Russell L.,Fokaidis Vasilios,Zhang Yongkang,Carton Thomas W.,Weiner Mark G.,Hall Jaclyn,Wang Fei.Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program[EB/OL].(2025-03-28)[2025-08-02].https://www.medrxiv.org/content/10.1101/2022.10.13.22281010.点此复制
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