COVID-19 Associated Mortality and Cardiovascular Disease Outcomes Among U.S. Women Veterans
Background
The burden of COVID-19 has been noted to be disproportionately greater in minority women, a population that is nevertheless still understudied in COVID-19 research.
Methods
We conducted a case-control cohort study to examine COVID-19-associated mortality and cardiovascular disease outcomes after testing (henceforth index) among a racially diverse adult women veteran population. We drew data from a Veterans Affairs (VA) national COVID-19 shared data repository, collected between February and August 2020. Kaplan-Meier curves and the Cox proportional hazards model were employed to examine the distribution of time to death and the effects of baseline predictors on mortality risk. Generalized linear models were used to examine 60-day cardiovascular disease outcomes. Covariates studied included age, body mass index (BMI), and active smoking status at index, and pre-existing conditions of diabetes, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and a history of treatment with antiplatelet or anti-thrombotic drug at any time in the 2 years prior to the index date.
Results
Women veterans who tested positive for SARS-CoV-2 had 4 times higher mortality risk than women veterans who tested negative (Hazard Ratio 3.8, 95% Confidence Interval CI 2.92 to 4.89) but had lower risk of cardiovascular events (Odds Ratio OR 0.78, 95% CI 0.66 to 0.92) and developing new heart disease conditions within 60 days (OR 0.67, 95% CI 0.58 to 0.77). Older age, obesity (BMI > 30), and prior CVD and COPD conditions were positively associated with increased mortality in 60 days. Despite a higher infection rate among minority women veterans, there was no significant race difference in mortality, cardiovascular events, or onset of heart disease.
Conclusions and Relevance
SARS-CoV-2 infection increased short-term mortality risk among women veterans similarly across race groups. However, there was no evidence of increased cardiovascular disease incidence in 60 days. A longer follow-up of women veterans who tested positive is warranted.
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Posted 28 Dec, 2020
On 08 Feb, 2021
Received 14 Jan, 2021
Received 14 Jan, 2021
Received 14 Jan, 2021
Received 14 Jan, 2021
On 09 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
Invitations sent on 05 Jan, 2021
On 05 Jan, 2021
On 22 Dec, 2020
On 22 Dec, 2020
On 15 Dec, 2020
COVID-19 Associated Mortality and Cardiovascular Disease Outcomes Among U.S. Women Veterans
Posted 28 Dec, 2020
On 08 Feb, 2021
Received 14 Jan, 2021
Received 14 Jan, 2021
Received 14 Jan, 2021
Received 14 Jan, 2021
On 09 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
On 05 Jan, 2021
Invitations sent on 05 Jan, 2021
On 05 Jan, 2021
On 22 Dec, 2020
On 22 Dec, 2020
On 15 Dec, 2020
Background
The burden of COVID-19 has been noted to be disproportionately greater in minority women, a population that is nevertheless still understudied in COVID-19 research.
Methods
We conducted a case-control cohort study to examine COVID-19-associated mortality and cardiovascular disease outcomes after testing (henceforth index) among a racially diverse adult women veteran population. We drew data from a Veterans Affairs (VA) national COVID-19 shared data repository, collected between February and August 2020. Kaplan-Meier curves and the Cox proportional hazards model were employed to examine the distribution of time to death and the effects of baseline predictors on mortality risk. Generalized linear models were used to examine 60-day cardiovascular disease outcomes. Covariates studied included age, body mass index (BMI), and active smoking status at index, and pre-existing conditions of diabetes, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and a history of treatment with antiplatelet or anti-thrombotic drug at any time in the 2 years prior to the index date.
Results
Women veterans who tested positive for SARS-CoV-2 had 4 times higher mortality risk than women veterans who tested negative (Hazard Ratio 3.8, 95% Confidence Interval CI 2.92 to 4.89) but had lower risk of cardiovascular events (Odds Ratio OR 0.78, 95% CI 0.66 to 0.92) and developing new heart disease conditions within 60 days (OR 0.67, 95% CI 0.58 to 0.77). Older age, obesity (BMI > 30), and prior CVD and COPD conditions were positively associated with increased mortality in 60 days. Despite a higher infection rate among minority women veterans, there was no significant race difference in mortality, cardiovascular events, or onset of heart disease.
Conclusions and Relevance
SARS-CoV-2 infection increased short-term mortality risk among women veterans similarly across race groups. However, there was no evidence of increased cardiovascular disease incidence in 60 days. A longer follow-up of women veterans who tested positive is warranted.
Figure 1
Figure 2
Figure 3
Figure 4