COVID-19-Associated Mortality in US Veterans with and without SARS-CoV-2 Infection

Ayako Suzuki, Jimmy T. Efird, Thomas S. Redding, Andrew D. Thompson, Ashlyn M. Press, Christina D. Williams, Christopher J. Hostler and Christine M. Hunt
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Ayako Suzuki: Division of Gastroenterology, Duke University, Durham, NC 27710, USA
Jimmy T. Efird: VA Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Thomas S. Redding: VA Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Andrew D. Thompson: VA Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Ashlyn M. Press: VA Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Christina D. Williams: VA Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Christopher J. Hostler: Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA
Christine M. Hunt: Division of Gastroenterology, Duke University, Durham, NC 27710, USA

IJERPH, 2021, vol. 18, issue 16, 1-13

Abstract: Background: We performed an observational Veterans Health Administration cohort analysis to assess how risk factors affect 30-day mortality in SARS-CoV-2-infected subjects relative to those uninfected. While the risk factors for coronavirus disease 2019 (COVID-19) have been extensively studied, these have been seldom compared with uninfected referents. Methods: We analyzed 341,166 White/Black male veterans tested for SARS-CoV-2 from March 1 to September 10, 2020. The relative risk of 30-day mortality was computed for age, race, ethnicity, BMI, smoking status, and alcohol use disorder in infected and uninfected subjects separately. The difference in relative risk was then evaluated between infected and uninfected subjects. All the analyses were performed considering clinical confounders. Results: In this cohort, 7% were SARS-CoV-2-positive. Age >60 and overweight/obesity were associated with a dose-related increased mortality risk among infected patients relative to those uninfected. In contrast, relative to never smoking, current smoking was associated with a decreased mortality among infected and an increased mortality in uninfected, yielding a reduced mortality risk among infected relative to uninfected. Alcohol use disorder was also associated with decreased mortality risk in infected relative to the uninfected. Conclusions: Age, BMI, smoking, and alcohol use disorder affect 30-day mortality in SARS-CoV-2-infected subjects differently from uninfected referents. Advanced age and overweight/obesity were associated with increased mortality risk among infected men, while current smoking and alcohol use disorder were associated with lower mortality risk among infected men, when compared with those uninfected.

Keywords: COVID-19; risk factor; mortality; smoking (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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