A Phenome-Wide Association Study (PheWAS) of COVID-19 Outcomes by Race Using the Electronic Health Records Data in Michigan Medicine

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Abstract

Background: We performed a phenome-wide association study to identify pre-existing conditions related to Coronavirus disease 2019 (COVID-19) prognosis across the medical phenome and how they vary by race. Methods: The study is comprised of 53,853 patients who were tested/diagnosed for COVID-19 between 10 March and 2 September 2020 at a large academic medical center. Results: Pre-existing conditions strongly associated with hospitalization were renal failure, pulmonary heart disease, and respiratory failure. Hematopoietic conditions were associated with intensive care unit (ICU) admission/mortality and mental disorders were associated with mortality in non-Hispanic Whites. Circulatory system and genitourinary conditions were associated with ICU admission/mortality in non-Hispanic Blacks. Conclusions: Understanding pre-existing clinical diagnoses related to COVID-19 outcomes informs the need for targeted screening to support specific vulnerable populations to improve disease prevention and healthcare delivery.

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  1. SciScore for 10.1101/2020.06.29.20141564: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.


    Results 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:
    Figures 2B-2D show that the disease categories that comprise the top 50 hits by prognostic outcome by race are different (with the caveat that for ICU admission and mortality these hits are largely suggestive due to limited power). Our results can inform targeted prevention across racial groups, which includes increased testing and encouraging self-isolation from household members with specific disease profiles along with education of enhanced public health prevention guidelines. There are several limitations to this analysis. First, there is the agnostic nature of PheWAS, which can identify potentially spurious associations. While we feel that many of the top traits have been highlighted elsewhere and are biologically plausible, there is currently no process in place for rapidly discerning potentially novel from spurious associations[24] beyond extensive manual review and follow-up research, particularly for a novel disease. Second, many of the issues with utilizing EHR data for research purposes also applies here including inaccurate data from billing codes[20] and failure of physicians to report/record problems.[21] Third, the sample size for a PheWAS is still rather small to be able to identify statistically significant associations – particularly for mortality. Moreover, we did not distinguish between transfer patients (i.e., those who were diagnosed elsewhere and transferred to MM for treatment), who may have been sicker patients than the cohort diagnosed at MM. However...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.