Key Points Question What are the risk factors associated with hospitalization, mechanical ventilation, and death among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? Findings In this national cohort study of 88 747 veterans tested for SARS-CoV-2, hospitalization, mechanical ventilation, and mortality were significantly higher in patients with positive SARS-CoV-2 test results than among those with negative test results. Significant risk factors for mortality included older age, high regional coronavirus disease 2019 burden, higher Charlson Comorbidity Index score, fever, dyspnea, and abnormal results in many routine laboratory tests; however, obesity, Black race, Hispanic ethnicity, chronic obstructive pulmonary disease, hypertension, and smoking were not associated with mortality. Meaning In this study, most deaths from SARS-CoV-2 occurred in patients with age of 50 years or older, male sex, and greater comorbidity burden.

Background and Aims. Whether patients with cirrhosis have increased risk of SARS-CoV-2 infection and the extent to which infection and cirrhosis increase the risk of adverse patient outcomes remain unclear. Approach and Results: We identified 88,747 patients tested for SARS-CoV-2 between 3/1/20-5/14/20 in the Veterans Affairs (VA) national healthcare system, including 75,315 with no cirrhosis-SARS-CoV-2 negative (C0-S0), 9826 with no cirrhosis-SARS-CoV-2 positive (C0-S1); 3301 with cirrhosis-SARS-CoV-2 negative (C1-S0); and 305 with cirrhosis-SARS-CoV-2 positive (C1-S1). Patients were followed through 6/22/20. Hospitalization, mechanical ventilation and death were modeled in time-to-event analyses using Cox proportional hazards regression. Patients with cirrhosis were less likely to test positive than patients without cirrhosis (8.5% vs. 11.5%, adjusted odds ratio 0.83, 95% CI 0.69-0.99). Thirty-day mortality and ventilation rates increased progressively from C0-S0 (2.3% and 1.6%), to C1-S0 (5.2% and 3.6%), to C0-S1 (10.6% and 6.5%), to C1-S1(17.1% and 13.0%). Among patients with cirrhosis, those who tested positive for SARS-CoV-2 were 4.1 times more likely to undergo mechanical ventilation (adjusted hazard ratio [aHR] 4.12, 95% CI 2.79-6.10) and 3.5 times more likely to die (aHR 3.54, 95% CI 2.55-4.90) than those who tested negative. Among patients with SARS-CoV-2 infection, those with cirrhosis were more likely to be hospitalized (aHR 1.37, 95% CI 1.12-1.66), undergo ventilation (aHR 1.61, 95% CI 1.05-2.46) or die (aHR 1.65, 95% CI 1.18-2.30) than patients without cirrhosis. Among patients with cirrhosis and SARS-CoV-2 infection, the most important predictors of mortality were advanced age, cirrhosis decompensation and high MELD score. Conclusions: SARS-CoV-2 infection was associated with a 3.5-fold increase in mortality in patients with cirrhosis. Cirrhosis was associated with a 1.7-fold increase in mortality in patients with SARS-CoV-2 infection.

In a target trial emulation study that included nearly 6 million predominately male patients receiving care in the U.S. Department of Veterans Affairs health care system, those receiving messenger RNA vaccines against SARS-CoV-2 were matched 1:1 to unvaccinated controls according to demographic, clinical, and geographic characteristics and followed for SARS-CoV-2 infection or SARS-CoV-2–related death to determine vaccine efficacy.

Background Identifying risk factors for SARS-CoV-2 infection could help health systems improve testing and screening strategies. Objectives Identify demographic factors, comorbid conditions, and symptoms independently associated with testing positive for SARS-CoV-2. Design Observational cross-sectional study. Setting Veterans Health Administration. Patients Persons tested for SARS-CoV-2 nucleic acid by polymerase chain reaction (PCR) between March 1 and May 14, 2020. Measurements Associations between demographic characteristics, diagnosed comorbid conditions, and documented symptoms with testing positive for SARS-CoV-2. Results Of 88,747 persons tested, 10,131 (11.4%) were SARS-CoV-2 PCR positive. Positivity was associated with older age (≥80 vs. <50 years: aOR 2.16, 95% CI 1.97-2.37), male sex (aOR 1.45, 95% CI 1.34-1.57), regional SARS-CoV-2 burden (≥2,000 vs. <400 cases/million: aOR 5.43, 95% CI 4.97-5.93), urban residence (aOR 1.78, 95% CI 1.70-1.87), Black (aOR 2.15, 95% CI 2.05-2.26) or American Indian/Alaska Native/Pacific Islander (aOR 1.26, 95% CI 1.05-1.52) vs. White race, and Hispanic ethnicity (aOR 1.52, 95% CI 1.40-1.65). Obesity and diabetes were the only two medical conditions associated with testing positive. Documented fevers, chills, cough, and diarrhea were also associated with testing positive. The population attributable fraction of positive tests was highest for regional SARS-CoV-2 burden (35.3%), followed by demographic variables (27.2%), symptoms (12.0%), obesity (10.5%), and diabetes (0.4%). Limitations Lack of information on SARS-CoV-2 exposures or the indications for testing which may affect the likelihood of testing positive. Conclusion The majority of positive SARS-CoV-2 tests were attributed to regional SARS-CoV-2 burden, demographic characteristics and obesity with a minor contribution of chronic comorbid conditions.

study promoting activity and changes in eating (PACE): design and baseline results. Obesity. 2007;15(Suppl 1):4S-15S.Objective: Based on previous worksite-wide intervention studies and an ecological framework, we created a behavioral intervention program to maintain or reduce weight through healthy eating and physical activity. The design and evaluation plan of the group-randomized trial and the recruitment of worksites are described. Preliminary results regarding the dietary and physical activity behaviors associated with BMI are discussed. Research Methods and Procedures:The intervention used an ecological framework modified by qualitative methods that identified salient barriers and facilitators of behavioral change. Approximately 30 transportation, manufacturing, utilities, personal, household, and miscellaneous service companies in the greater Seattle area are being recruited to the trial. The study population for the present analysis consists of 18 worksites from the first two randomization waves. Dietary behavior was assessed, not by calories, but by behavioral measures related to BMI. Physical activity behaviors were surveyed. BMI is derived from reported height and weight at baseline. Results: The intervention has been developed with a specified minimum suite of strategies within the defined framework. Response rates to the baseline survey among the 18 worksites are 81% on average. After adjusting for age, gender, race, and education, BMI was associated with frequency of intensity-adjusted physical activity, sweat-inducing exercise, fast food meals, soft drinks, eating while doing another activity, and fruit and vegetable intake. Discussion: Worksite-wide intervention strategies can be adapted to target obesity prevention. Employees are willing to participate in surveys at high rates. Several measures of physical activity and eating choices are associated with baseline BMI.