Severe Acute Respiratory Syndrome Coronavirus 2 Incidence and Risk Factors in a National, Community-Based Prospective Cohort of US Adults

  1. Denis Nash
  2. Madhura S Rane
  3. McKaylee M Robertson
  4. Mindy Chang
  5. Sarah Gorrell Kulkarni
  6. Rebecca Zimba
  7. William You
  8. Amanda Berry
  9. Chloe Mirzayi
  10. Shivani Kochhar
  11. Andrew Maroko
  12. Drew A Westmoreland
  13. Angela M Parcesepe
  14. Levi Waldron
  15. Christian Grov

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Abstract

Background

Prospective cohort studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence complement case-based surveillance and cross-sectional seroprevalence surveys.

Methods

We estimated the incidence of SARS-CoV-2 infection in a national cohort of 6738 US adults, enrolled in March–August 2020. Using Poisson models, we examined the association of social distancing and a composite epidemiologic risk score with seroconversion. The risk score was created using least absolute shrinkage selection operator (LASSO) regression to identify factors predictive of seroconversion. The selected factors were household crowding, confirmed case in household, indoor dining, gathering with groups of ≥10, and no masking in gyms or salons.

Results

Among 4510 individuals with ≥1 serologic test, 323 (7.3% [95% confidence interval (CI), 6.5%–8.1%]) seroconverted by January 2021. Among 3422 participants seronegative in May–September 2020 and retested from November 2020 to January 2021, 161 seroconverted over 1646 person-years of follow-up (9.8 per 100 person-years [95% CI, 8.3–11.5]). The seroincidence rate was lower among women compared with men (incidence rate ratio [IRR], 0.69 [95% CI, .50–.94]) and higher among Hispanic (2.09 [1.41–3.05]) than white non-Hispanic participants. In adjusted models, participants who reported social distancing with people they did not know (IRR for always vs never social distancing, 0.42 [95% CI, .20–1.0]) and with people they knew (IRR for always vs never, 0.64 [.39–1.06]; IRR for sometimes vs never, 0.60 [.38–.96]) had lower seroconversion risk. Seroconversion risk increased with epidemiologic risk score (IRR for medium vs low score, 1.68 [95% CI, 1.03–2.81]; IRR for high vs low score, 3.49 [2.26–5.58]). Only 29% of those who seroconverted reported isolating, and only 19% were asked about contacts.

Conclusions

Modifiable risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the United States.

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  1. Version published to 10.1093/cid/ciac423
  2. ScreenIT

    SciScore for 10.1101/2021.02.12.21251659: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical Approval: The study protocol was approved by the Institutional Review Board at the City University of New York (CUNY) Graduate School for Public Health and Health Policy.
    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:
    Our study also has limitations worth noting. Most research studies deployed in the middle of a pandemic, including ours, may produce biased estimates since they may not include complete information on participants who died from COVID-19, or were too sick or otherwise too busy to participate in the research activities, or enrolled but became lost to follow-up. Moreover, it is possible that those who thought they had SARS-CoV-2 or were tested outside the study may have been more or less likely to participate in follow-up serologic testing, which would lead our seroincidence estimates to be biased in either direction. However, there was no systematic difference between those who tested in Period 1 and Period 2 (Table S1). Separately, while we have corrected our cumulative incidence estimates for laboratory test error18, the observed cumulative incidence in our cohort may be lower than the true cumulative incidence in our cohort because of waning of SARS-CoV-2 antibodies. Recent studies suggest waning of antibodies to both nucleocapsid and spike proteins2, which combined with the timing of specimen collection relative to infection for many participants in our cohort (median of 190 days)9, could mean that we have underestimated the true cumulative incidence. Next, as with any observational cohort study, estimated associations between SARS-CoV-2 risk factors and incidence are subject to confounding. The crude associations we presented could be over- or underestimated, and also may ...

    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 10.1101/2021.02.12.21251659 on medRxiv