Abstract
Objectives: To identify factors associated with COVID-19 test positivity and assess viral and antibody test concordance.
Design: Observational retrospective cohort study.
Setting: Optum de-identified electronic health records including over 700 hospitals and 7000 clinics in the USA.
Participants: There were 891 754 patients who had a COVID-19 test identified in their electronic health record between 20 February 2020 and 10 July 2020.
Primary and secondary outcome measures: Per cent of viral and antibody tests positive for COVID-19 (‘positivity rate’); adjusted ORs for factors associated with COVID-19 viral and antibody test positivity; and per cent concordance between positive viral and subsequent antibody test results.
Results: Overall positivity rate was 9% (70 472 of 771 278) and 12% (11 094 of 91 741) for viral and antibody tests, respectively. Positivity rate was inversely associated with the number of individuals tested and decreased over time across regions and race/ethnicities. Antibody test concordance among patients with an initial positive viral test was 91% (71%-95% depending on time between tests). Among tests separated by at least 2 weeks, discordant results occurred in 7% of patients and 9% of immunocompromised patients. Factors associated with increased odds of viral and antibody positivity in multivariable models included: male sex, Hispanic or non-Hispanic black or Asian race/ethnicity, uninsured or Medicaid insurance and Northeast residence. We identified a negative dose effect between the number of comorbidities and viral and antibody test positivity. Paediatric patients had reduced odds (OR=0.60, 95% CI 0.57 to 0.64) of a positive viral test but increased odds (OR=1.90, 95% CI 1.62 to 2.23) of a positive antibody test compared with those aged 18-34 years old.
Conclusions: This study identified sociodemographic and clinical factors associated with COVID-19 test positivity and provided real-world evidence demonstrating high antibody test concordance among viral-positive patients.
Keywords: COVID-19; epidemiology; infectious diseases; molecular diagnostics; public health.
【저자키워드】 COVID-19, Infectious diseases, Epidemiology, public health., molecular diagnostics, 【초록키워드】 public health, antibody, hospital, Immunocompromised patients, Electronic health record, clinics, Region, Health, Concordance, antibody tests, Patient, Antibody test, molecular, USA, patients, Hispanic, Evidence, dose, Male sex, COVID-19 test, retrospective cohort study, Asian, Factor, Medicaid, 95% CI, individual, secondary outcome, multivariable model, positive, Sociodemographic, antibody test results, initial, tested, identify, occurred, subsequent, provided, reduced, adjusted, separated, clinical factor, number of comorbidity, with COVID-19, 【제목키워드】 Electronic health record, Antibody test, USA, retrospective cohort study, Factor, with COVID-19,