We compared infection prevalence with linear regression, using reference groups O for ABO and Rh-positive for Rh(D) and using bootstrap to compute 95% confidence intervals for each estimate 57. We evaluated potential confounding due to population stratification using a multivariate analysis, and we report clinically meaningful measures of effect.īlood-type frequencies vary across ancestry groups 56, so we evaluated the confounding effect of ancestry by adjusting for race/ethnicity (proxies for ancestry). We compared both ABO and Rh(D) blood types, and we investigated initial infection status and two severe COVID-19 outcomes: intubation and death. In this study, we sought to understand the association between SARS-CoV-2 infection/COVID-19 and blood type using electronic health record (EHR) data from NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC) hospital in New York City, USA. Other studies have found evidence that Rh-positive individuals are protected against the effects of latent toxoplasmosis 51, though Toxoplasma gondii is a eukaryotic parasite 52, not a virus like SARS-CoV-2. For example, hemolytic disease of the newborn is a concern when Rh(D) is mismatched between mother and offspring 50. Like ABO, Rh type is important for type compatibility and immune response. Rh(D) phenotypes (positive and negative Rh blood types) are associated with very few diseases compared to ABO 49. pylori 45, Norwalk virus 46, hepatitis B virus 47, and N. In addition, previous work has identified associations between ABO blood groups and a number of different infections or disease severity following infections, including SARS-CoV-1 43, P. The numerous associations between conditions and both blood type and COVID-19 provide reason to believe that true associations may exist between blood type and morbidity and mortality due to COVID-19. For example, coagulopathy is a common issue for COVID-19 patients 35, 36, 37, 38, 39, 40, 41, and risk of venous thromboembolism must be carefully managed 42. These conditions are also relevant for COVID-19. A 2012 meta-analysis found that, in addition to individual variants, a non-O blood type is among the most important genetic risk factors for venous thromboembolism 34. For example, genome-wide association studies have associated variants within ABO to activity of the angiotensin converting enzyme 7, red blood cell count, hemoglobin concentration, hematocrit 8, 9, 10, 11, von Willebrand factor 12, 13, 14, 15, myocardial infarction 16, 17, coronary artery disease 17, 18, 19, 20, 21, ischemic stroke 13, 19, 22, type 2 diabetes 23, 24, 25, and venous thromboembolism 26, 27, 28, 29, 30, 31, 32, 33. This gene is associated with a number of other traits, including risk factors for COVID-19 morbidity and mortality. The ABO blood type trait reflects polymorphisms within the ABO gene. Conversely, however, they estimated lower odds of mechanical ventilation for all non-O types, though the estimated odds ratios were not statistically significant at the 5% level for this outcome. found 6 a higher risk of COVID-19 among A and a lower risk among O blood types. Similarly, using a meta-analysis of data from Italy and Spain, Ellinghaus et al. found a greater proportion of A and a lower proportion of O blood types among COVID-19 patients, relative to the general populations of Wuhan and Shenzhen 5. Using data from Wuhan and Shenzhen, Zhao et al. Recent work has demonstrated an association between ABO blood types and COVID-19 risk. A number of risk factors for COVID-19 morbidity and mortality are known, including age, sex, smoking, hypertension, diabetes, and chronic cardiovascular and respiratory diseases 3, 4. As of August 22, New York City has recorded 228,144 confirmed infections and 19,014 deaths 2. Within the United States, New York suffered among the worst outbreaks during the early phases of the pandemic. The novel Coronavirus disease (COVID-19, caused by the SARS-CoV-2 virus) has spread rapidly across the globe and has caused over 21.1 million confirmed infections and over 761,000 deaths worldwide as of Aug1.
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