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Leong DP, Loeb M, Mony PK, Rangarajan S, Mushtaha M, Miller MS, Dias M, Yegorov S, V M, Telci Caklili O, Temizhan A, Szuba A, Abat MEM, Mat-Nasir N, Diaz ML, Khansaheb H, Lopez-Jaramillo P, Duong M, Teo KK, Poirier P, Oliveira G, Avezum Á, Yusuf S. Risk factors for recognized and unrecognized SARS-CoV-2 infection: a seroepidemiologic analysis of the Prospective Urban Rural Epidemiology (PURE) study. Microbiol Spectr 2024; 12:e0149223. [PMID: 38214526 PMCID: PMC10845948 DOI: 10.1128/spectrum.01492-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/26/2023] [Indexed: 01/13/2024] Open
Abstract
There are limited data on individual risk factors for SARS-CoV-2 infection (including unrecognized infection). In this seroepidemiologic substudy of an ongoing prospective cohort study of community-dwelling adults, participants were thoroughly characterized pre-pandemic. The SARS-CoV-2 infection was ascertained by serology. Among 8,719 participants from 11 high-, middle-, and low-income countries, 3,009 (35%) were seropositive for SARS-CoV-2. Characteristics independently associated with seropositivity were younger age (odds ratio, OR; 95% confidence interval, CI, per five-year increase: 0.95; 0.91-0.98) and body mass index >25 kg/m2 (OR, 95% CI: 1.16, 1.01-1.34). Smoking (as compared with never smoking, OR, 95% CI: 0.83, 0.70-0.97) and COVID-19 vaccination (OR, 95% CI: 0.70, 0.60-0.82) were associated with a reduced risk of seropositivity. Among seropositive participants, 83% were unaware of having been infected with SARS-CoV-2. Seropositivity and a lack of awareness of infection were more common in lower-income countries. The COVID-19 vaccination reduces the risk of SARS-CoV-2 infection (including recognized and unrecognized infections). Overweight or obesity is an independent risk factor for SARS-CoV-2 infection. Infection and lack of infection awareness are more common in lower-income countries.IMPORTANCEIn this large, international study, evidence of SARS-CoV-2 infection was obtained by testing blood specimens from 8,719 community-dwelling adults from 11 countries. The key findings are that (i) the large majority (83%) of community-dwelling adults from several high-, middle-, and low-income countries with blood test evidence of SARS-CoV-2 infection were unaware of this infection-especially in lower-income countries; and (ii) overweight/obesity predisposes to SARS-CoV-2 infection, while COVID-19 vaccination is associated with a reduced risk of SARS-CoV-2 infection. These observations are not attributable to other individual characteristics, highlighting the importance of the COVID-19 vaccination to prevent not only severe infection but possibly any infection. Further research is needed to understand the mechanisms by which overweight/obesity might increase the risk of SARS-CoV-2 infection.
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Affiliation(s)
- Darryl P. Leong
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Prem K. Mony
- Division of Epidemiology and Population Health, St. John’s Research Institute, St. John’s Medical College, Bangalore, India
| | - Sumathy Rangarajan
- The Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Maha Mushtaha
- The Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Matthew S. Miller
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Mary Dias
- Department of Microbiology and Infectious Diseases, St. John’s Medical College, Bangalore, India
| | - Sergey Yegorov
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Mamatha V
- Department of Microbiology and Infectious Diseases, St. John’s Medical College, Bangalore, India
| | - Ozge Telci Caklili
- Department of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey
| | - Ahmet Temizhan
- Cardiology Department, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Marc Evans M. Abat
- Department of Medicine, Philippine General Hospital, Manila, Philippines
| | - Nafiza Mat-Nasir
- Department of Primary Care Medicine, Universiti Teknologi MARA (UiTM), Petaling Jaya, Malaysia
| | - Maria Luz Diaz
- Estudios Clinicos Latinamérica (ECLA), Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | | | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Koon K. Teo
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Québec, Canada
| | | | | | - Salim Yusuf
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
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