SARS-CoV-2 Antibody Prevalence and Association with Routine Laboratory Values in a Life Insurance Applicant Population
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Abstract
Objectives
The prevalence of SARS-CoV-2 antibodies in the general population is largely unknown. Since many infections, even among the elderly and other vulnerable populations, are asymptomatic, the prevalence of antibodies could help determine how far along the path to herd immunity the general population has progressed. Also, in order to clarify the clinical manifestations of current or recent past COVID-19 illness, it may be useful to determine if there are any common alterations in routine clinical laboratory values.
Methods
We performed SARS-CoV-2 antibody tests on 50,130 consecutive life insurance applicants who were having blood drawn for the purpose of underwriting (life risk assessment). Subjects were also tested for lipids, liver function tests, renal function studies, as well as serum proteins. Other variables included height, weight, blood pressure at the time of the blood draw, and history of common chronic diseases (hypertension, heart disease, diabetes, and cancer).
Results
The overall prevalence of SARS-CoV-2 was 3.0%, and was fairly consistent across the age range and similar in males and females. Several of the routine laboratory tests obtained were significantly different in antibody-positive vs. antibody-negative subjects, including albumin, globulins, bilirubin, and the urine albumin:creatinine ratio. The BMI was also significantly higher in the antibody-positive group. Geographical distribution revealed a very high level of positivity in the state of New York compared to all other areas (17.1%). Using state population data from the US Census, it is estimated that this level of seropositivity would correspond to 6.98 million (99% CI: 6.56-7.38 million) SARS-CoV-2 infections in the US, which is 3.8 times the cumulative number of cases in the US reported to the CDC as of June 1, 2020.
Conclusions
The estimated number of total SARS-CoV-2 infections based on positive serology is substantially higher than the total number of cases reported to the CDC. Certain laboratory values, particularly serum protein levels, are associated with positive serology, though these associations are not likely to be clinically meaningful.
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SciScore for 10.1101/2020.09.09.20191296: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Western Institutional Review Board’s (WIRB’s) IRB Affairs Department reviewed the study under the Common Rule and applicable guidance and determined it is exempt under 45 CFR §46.104(d)(4) using de-identified study samples for epidemiologic investigation. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Between May12th and June 25th 2020, 50,130 individuals were tested for antibodies to SARSCoV-2. SARSCoV-2suggested: NoneThe antibody tests were performed using the Roche Elecsys Anti-SARS-CoV-2 kit on the Roche 602 analyzer, with a stated … SciScore for 10.1101/2020.09.09.20191296: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Western Institutional Review Board’s (WIRB’s) IRB Affairs Department reviewed the study under the Common Rule and applicable guidance and determined it is exempt under 45 CFR §46.104(d)(4) using de-identified study samples for epidemiologic investigation. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources Between May12th and June 25th 2020, 50,130 individuals were tested for antibodies to SARSCoV-2. SARSCoV-2suggested: NoneThe antibody tests were performed using the Roche Elecsys Anti-SARS-CoV-2 kit on the Roche 602 analyzer, with a stated sensitivity of 100% and specificity of 99.8%, utilizing an electrochemiluminescence immunoassay. Anti-SARS-CoV-2suggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Weaknesses of the study include the imbalanced representation of the US states, as well as the lack of samples from those under age 20 or over age 80. The age distribution is also more heavily weighted to the young adult years, which is not representative of the US population. Although the sample size was large, it was not large enough to stratify by both age and geography when estimating population seroprevalence. Finally, the life insurance-buying population tends to be both healthier and wealthier than average, and this could also bias the results in an indeterminate direction.
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.
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