Case–control study of the association of chronic acid suppression and social determinants of health with COVID-19 infection

  1. Bing Zhang
  2. Anna L. Silverman
  3. Saroja Bangaru
  4. Douglas Arneson
  5. Sonya Dasharathy
  6. Nghia Nguyen
  7. Diane Rodden
  8. Jonathan Shih
  9. Atul J. Butte
  10. Wael Noor El-Nachef
  11. Brigid S. Boland
  12. Vivek Ashok Rudrapatna

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Abstract

Acid suppressants are widely-used classes of medications linked to increased risks of aerodigestive infections. Prior studies of these medications as potentially reversible risk factors for COVID-19 have been conflicting. We aimed to determine the impact of chronic acid suppression use on COVID-19 infection risk while simultaneously evaluating the influence of social determinants of health to validate known and discover novel risk factors. We assessed the association of chronic acid suppression with incident COVID-19 in a 1:1 case–control study of 900 patients tested across three academic medical centers in California, USA. Medical comorbidities and history of chronic acid suppression use were manually extracted from health records by physicians following a pre-specified protocol. Socio-behavioral factors by geomapping publicly-available data to patient zip codes were incorporated. We identified no evidence to support an association between chronic acid suppression and COVID-19 (adjusted odds ratio 1.04, 95% CI 0.92–1.17, P  = 0.515). However, several medical and social features were positive (Latinx ethnicity, BMI ≥ 30, dementia, public transportation use, month of the pandemic) and negative (female sex, concurrent solid tumor, alcohol use disorder) predictors of new infection. These findings demonstrate the value of integrating publicly-available databases with medical data to identify critical features of communicable diseases.

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  1. Version published to 10.1038/s41598-021-00367-7
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    SciScore for 10.1101/2021.01.10.21249545: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the Institutional Review Board (IRB) of the University of California, San Francisco (UCSF; IRB #20-30549).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A notable limitation of this study is the reliance of self-reported COVID-19 when testing was available. The study reported a COVID-19 prevalence of 6.4% which was higher than the national estimates at the time, raising concerns regarding the accuracy of self-report. Furthermore, the survey was administered in English, functionally excluding the near quarter of US Census respondents who report limited to no English proficiency.30 Medical Comorbidities and SARS-CoV-2 Risk: Consistent with previous data, our cohort found an increased risk of COVID-19 and a BMI > 30.31-35 Furthermore, patients with dementia were more likely to test positive, possibly reflecting frequent interactions with the healthcare sytem or caregivers and a decreased ability to socially distance. Interestingly, those with underlying solid tumors or alcohol use disorder had a lower risk of infection with SARS-CoV-2. We surmised that this may be due to reduced exposure to infected individuals by spending significant time at home and adhering more strictly to precautions, but still having a high need for medical services and therefore receiving more testing. Finally, the negative association between COVID-19 positivity and GERD may reflect functional hearburn, which is comorbid with anxiety and possible proclivity to be tested.36 Sociodemographic Factors and SARS-CoV-2 Risk: An important finding of our study is that members of the Latinx community are at a disproportionate risk of contracting SARS-CoV-2, even a...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.01.10.21249545v1 on medRxiv