Microbiology Spectrum (Feb 2024)

Risk factors for recognized and unrecognized SARS-CoV-2 infection: a seroepidemiologic analysis of the Prospective Urban Rural Epidemiology (PURE) study

  • Darryl P. Leong,
  • Mark Loeb,
  • Prem K. Mony,
  • Sumathy Rangarajan,
  • Maha Mushtaha,
  • Matthew S. Miller,
  • Mary Dias,
  • Sergey Yegorov,
  • Mamatha V,
  • Ozge Telci Caklili,
  • Ahmet Temizhan,
  • Andrzej Szuba,
  • Marc Evans M. Abat,
  • Nafiza Mat-Nasir,
  • Maria Luz Diaz,
  • Hamda Khansaheb,
  • Patricio Lopez-Jaramillo,
  • MyLinh Duong,
  • Koon K. Teo,
  • Paul Poirier,
  • Gustavo Oliveira,
  • Álvaro Avezum,
  • Salim Yusuf

DOI
https://doi.org/10.1128/spectrum.01492-23
Journal volume & issue
Vol. 12, no. 2

Abstract

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ABSTRACTThere are limited data on individual risk factors for SARS-CoV-2 infection (including unrecognized infection). In this seroepidemiologic substudy of an ongoing prospective cohort study of community-dwelling adults, participants were thoroughly characterized pre-pandemic. The SARS-CoV-2 infection was ascertained by serology. Among 8,719 participants from 11 high-, middle-, and low-income countries, 3,009 (35%) were seropositive for SARS-CoV-2. Characteristics independently associated with seropositivity were younger age (odds ratio, OR; 95% confidence interval, CI, per five-year increase: 0.95; 0.91–0.98) and body mass index >25 kg/m2 (OR, 95% CI: 1.16, 1.01–1.34). Smoking (as compared with never smoking, OR, 95% CI: 0.83, 0.70–0.97) and COVID-19 vaccination (OR, 95% CI: 0.70, 0.60–0.82) were associated with a reduced risk of seropositivity. Among seropositive participants, 83% were unaware of having been infected with SARS-CoV-2. Seropositivity and a lack of awareness of infection were more common in lower-income countries. The COVID-19 vaccination reduces the risk of SARS-CoV-2 infection (including recognized and unrecognized infections). Overweight or obesity is an independent risk factor for SARS-CoV-2 infection. Infection and lack of infection awareness are more common in lower-income countries.IMPORTANCEIn this large, international study, evidence of SARS-CoV-2 infection was obtained by testing blood specimens from 8,719 community-dwelling adults from 11 countries. The key findings are that (i) the large majority (83%) of community-dwelling adults from several high-, middle-, and low-income countries with blood test evidence of SARS-CoV-2 infection were unaware of this infection—especially in lower-income countries; and (ii) overweight/obesity predisposes to SARS-CoV-2 infection, while COVID-19 vaccination is associated with a reduced risk of SARS-CoV-2 infection. These observations are not attributable to other individual characteristics, highlighting the importance of the COVID-19 vaccination to prevent not only severe infection but possibly any infection. Further research is needed to understand the mechanisms by which overweight/obesity might increase the risk of SARS-CoV-2 infection.

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