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Research Article
COVID-19 Associated Mortality and Cardiovascular Disease Outcomes Among U.S. Women Veterans
Haekyung Jeon-Slaughter
VA North Texas Health Care System
Corresponding Author
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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.
Keywords
Women, Veterans Affairs, COVID-19, mortality, cardiovascular disease, risk factors, SARS-CoV-2
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Posted 28 Dec, 2020
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Received 14 Jan, 2021
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Received 14 Jan, 2021
Reviewer #1 agreed
On 09 Jan, 2021
Reviewer #4 agreed
On 05 Jan, 2021
Reviewer #2 agreed
On 05 Jan, 2021
Reviewer #3 agreed
On 05 Jan, 2021
Reviewer #5 agreed
On 05 Jan, 2021
Reviewers invited
Invitations sent on 05 Jan, 2021
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On 05 Jan, 2021
Editor invited
On 22 Dec, 2020
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On 22 Dec, 2020
First submitted
On 15 Dec, 2020
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Subject Areas
Internal Medicine
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This preprint is under consideration at Scientific Reports. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
COVID-19 Associated Mortality and Cardiovascular Disease Outcomes Among U.S. Women Veterans
Haekyung Jeon-Slaughter
VA North Texas Health Care System
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 28 Dec, 2020
No community comments so far
Review #1 received
Received 14 Jan, 2021
Review #2 received
Received 14 Jan, 2021
Reviewer #1 agreed
On 09 Jan, 2021
Reviewer #4 agreed
On 05 Jan, 2021
Reviewer #2 agreed
On 05 Jan, 2021
Reviewer #3 agreed
On 05 Jan, 2021
Reviewer #5 agreed
On 05 Jan, 2021
Reviewers invited
Invitations sent on 05 Jan, 2021
Editor assigned
On 05 Jan, 2021
Editor invited
On 22 Dec, 2020
Submission checks complete
On 22 Dec, 2020
First submitted
On 15 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Internal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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