Clinical risk, sociodemographic factors, and changes over time in SARS-CoV-2 infection in Ontario, Canada

An explanation of the number of study participants and the reasons for inclusion and exclusion is summarized in the supplementary figure. 2..Overall, 3,167,753 eligible community-dwelling patients underwent RT-PCR testing for SARS-CoV-2 infection between January 1, 2020 and December 31, 2020, of which 142,814 (4.5%). Confirmed positive test (table) 1 And supplementary table 2). The figure shows the weekly number and percentage of community-dwelling individuals who were first positive for SARS-CoV-2 by age group. 1.. The supplementary chart shows the weekly number of individuals living in the area who have been tested for SARS-CoV-2 and the percentage of positive tests stratified by age group. Four.. During the first wave, the peak numbers and proportions of SARS-CoV-2 infected individuals identified in the laboratory reflect the standard incubation period for measuring effects, 3 weeks after the state-wide blockade. Occurred in the week starting April 12, 2020. Effect of public health measures on infection rate (supplementary figure. 1).³⁶..

The table below shows the baseline sociodemographic and clinical features of community-dwelling individuals with or without SARS-CoV-2 infection in the first wave (ie, early 2020). 1.. Compared to individuals without SARS-CoV-2 infection, individuals living in communities with SARS-CoV-2 infection are generally younger, more often male, immigrants, and racially / ethnically. I lived in a diverse, large, urban, low-income community.This trend continued until the end of 2020 (Supplementary Table) 2). In addition, SARS-CoV-2 infected individuals initially had a high incidence of diabetes, but otherwise had a lower incidence of most clinical comorbidities and a higher incidence of recent hospitalizations or ED visits. It was low and consistent until the end of 2020.

The table shows the independent predictors of SARS-CoV-2 infection found in the laboratory in the individuals residing in the area tested. 2.. The results take into account the detection of significant heterogeneity in the risk of SARS-CoV-2 infection by age, during the period before and immediately after the peak of the first wave of the state pandemic, and during the rest of 2020. It will be layered. As time passes(P-Interaction <0.0001). During the period leading up to the peak of the first wave of the pandemic, the likelihood of SARS-CoV-2 infection gradually increased in the age group (45-65 years, OR 1.30, 95% CI 1.24-1.37, 65-75 years). Has increased to. , OR 1.38, 95% CI 1.26–1.51; 75–85 years, OR 1.46, 95% CI 1.30–1.63; 85+, OR 1.60, 95% CI 1.41–1.81) with the youngest individual 18–45 years Comparison year. Other independent risk factors for SARS-CoV-2 infection include male gender (OR 1.45, 95% CI 1.31–1.60) and at least one-fifth of neighborhood income (OR 1.09, 95% CI 1.01–1.17). Includes more racial residence. / Ethnically diverse communities (OR 1.02, 95% CI 1.01–1.03 per 1% increase in regional race / ethnic diversity), immigrants to Canada (OR 1.53, 95% CI 1.45–1.61), Frailty (OR 1.31, 95% CI 1.01 – 1.25), hypertension (OR 1.10, 95% CI 1.04 – 1.17), and diabetes (OR 1.12, 95% CI 1.05 – 1.20).

Immediately after the peak of the first wave of the pandemic, the likelihood of SARS-CoV-2 infection confirmed in the laboratory across the age group of individuals residing in the area was reversed (supplementary figure). Four).Since then, the oldest individuals over the age of 85 were least likely to be infected with SARS-CoV-2 (Table). 2), The risk of infection gradually increases with age compared to individuals over 85 years (75-85 years, OR 1.11, 95% CI 0.97-1.28; 65-75 years, OR 1.23, 95%) CI 1.08 to 1.40; 45 to 65 years, OR 1.43, 95% CI 1.27 to 1.62, and 18 to 45 years, OR 1.58, 95% CI 1.40 to 1.80). In addition, over all low quintiles of neighborhood income compared to the highest quintile (5th quintile, OR 2.01, 95% CI 1.87–2.16; quintile 2, OR 1.53, 95% CI). The risk of SARS-CoV-2 infection has gradually increased. 1.43–1.65; quintile 3, OR 1.46, 95% CI 1.36–1.57; quintile 4, OR 1.27, 95% CI 1.17–1.37). Other independent risk factors include male gender (OR 1.67, 95% CI 1.52–1.83) and living in racially / ethnically diverse communities (OR 1% increase 1.05, 95% CI 1.03–1.06). ), Immigration to Canada (OR 1.82, 95% CI 1.75–1.90), history of hypertension (OR 1.07, 95% CI 1.01–1.12), and history of diabetes (OR 1.32, 95% CI 1.24–1.40).

Results up to the rest of 2020 are reported in the table 2.. Independent risk factors were young individuals (18-45 years, OR 1.09, 95% CI 1.03 ~) who were most likely to be infected with SARS-CoV-2 compared to the elderly (66-75 years, OR 0.87). 1.14) continued to be. , 95% CI 0.83–0.92; and age 76–85, or 0.85, 95% CI 0.81–0.90). The risk of infection in the lower quintiles of neighborhood income continued to increase gradually (quintile 1, OR 1.64, 95% CI 1.60–1.67; quintile 2, OR 1.45, 95% CI 1.42–1.48; Quantile 3, OR 1.39, 95% CI 1.36–1.42; Quantile 4, or 1.17, 95% CI 1.15–1.19). Other independent risk factors include male gender (OR 1.24, 95% CI 1.20–1.27) and living in racially / ethnically diverse communities (OR 1% increase 1.04, 95% CI 1.03–1.05). ), Immigration to Canada (OR 1.99, 95% CI 1.96–2.01), history of hypertension (OR 1.08, 95% CI 1.07–1.10), and history of diabetes (OR 1.33, 95% CI 1.30–1.36).

Absolute and relative risk of SARS-CoV-2 infection confirmed in the laboratory in community-dwelling individuals according to the number of independent risk factors identified above (eg, age category, male gender, low-income region). The chart shows the degree and duration of racial / ethnic diversity in the region), residence in Canada, immigration status in Canada, hypertension, diabetes, and a history of frailty before the peak of the pandemic). 2 And table 3.. Prior to the peak of the pandemic, SARS-CoV-2 infection rates were generally high across racial / ethnically diverse communities and among individuals with a high number of risk factors, with three or more other risk factors. Infection rates were similar to those of individuals living in the least racially / ethnically diverse communities with the risk factors of (Figure). 2a). Individuals with a risk factor of 1, 2, or 3 or higher had progressively higher odds for SARS-CoV-2 infection compared to individuals without risk factors across all areas of racial / ethnic diversity.

When the first wave of the pandemic peaked in mid-April and continued for the rest of 2020, infection rates declined across Ontario, but less in areas of high racial / ethnic diversity. rice field. In addition, the accumulation of more risk factors remained associated with a higher risk of SARS-CoV-2 infection in the most racially / ethnically diverse communities, but the risk factors are now 85 years old. All age groups below are included (figure). 2b and c; table 3). Immediately after the peak of the first wave, individuals living in the most racially / ethnically diverse communities with 2, 3, or 4 or more risk factors have an OR of SARS-CoV-2 infection of 1.89, 3.07, And 4.73. Their community with 0 to 1 risk factors. In contrast, in the least racially / ethnically diverse communities, there was little or no gradient in infection rates across risk groups. For the rest of 2020, absolute infection rates increased in all four quarters compared to immediately after the peak of the first wave, but of individuals living in the most racially / ethnically diverse communities. The OR for SARS-CoV-2 infection is 2. Risk factors of 3, or ≥4 remain significantly elevated at 1.66, 2.48, and 3.70, with little gradient in infection rates across risk groups among the least racially / ethnically diverse communities. There was not.