key: cord-0898744-bxuvrom0
authors: Vacca, Maria; Jefferson, Thomas; Vyas, Nikunj; Banks, Joshua; Joyce, Elaine; Hou, Cindy; Leiby, Benjamin E.; DeAngelo, Stefanie; Levin, Todd P.; Shingler-Nace, Autum; Mapp, Marilyn; Hiester, Ashlee; Coughenour, Jonathan H.
title: Analysis of Blood Type for SARS-CoV-2 and Correlation for Disease Acquisition in Various Sociodemographic Groups Including Women of Childbearing Age
date: 2022-03-18
journal: Am J Infect Control
DOI: 10.1016/j.ajic.2022.03.012
sha: 084e99646294167bd36673c48f54c4847f5569ef
doc_id: 898744
cord_uid: bxuvrom0

BACKGROUND: Multiple studies have occurred to determine if a patient's blood type, Rhesus factor (Rh), and sociodemographic attributes contribute to contracting SARS-CoV-2. True association remains unknown. METHODS: Inclusion criteria included in-patients were tested for SARS-CoV-2 with blood type assessed. Study endpoints combined ABO, Rh and all cause inpatient mortality (ACIM) with testing positivity. Pregnancy status was one of several secondary endpoints evaluated. A logistic regression analysis was used to estimate association. RESULTS: Of the 27,662 patients who met inclusion criteria, Type A blood was associated with increased positivity [1.01 (1.0-1.21), p=0.03]. Type B [1.10 (0.99-1.23), p=0.08] and AB [0.98 (0.81-1.19), p =0.84] showed no association. When evaluating ACIM, type A [1.18 (0.91-1.52), p=0.22], B [1.13 (0.82- 1.56), p=0.480], and AB [1.06 (0.62-1.81), p=0.839] were not associated with increased mortality. The female subgroup was less likely to test positive [0.88 (0.82-0.986), p=0.002]. Black patients demonstrated a higher likelihood of positivity when compared to White [1.96 (1.79-2.14), p<0.001]. Non-pregnant women exhibited a 2.5 times greater likelihood of testing positive [2.49 (2.04-3.04), p<0.001]. CONCLUSIONS: This study confirms results of previous research which showed SARS-Co-V-2 positivity related to blood type. It also confirms more recent research demonstrating inequities related to acquisition of SARS-CoV-2 for certain sociodemographic groups. Larger studies are warranted to confirm and further explore novel pregnancy findings.

Of the 27,662 patients who met inclusion criteria, Type A blood was associated with increased positivity [1. 

This study confirms results of previous research which showed SARS-Co-V-2 positivity related to blood type. It also confirms more recent research demonstrating inequities related to acquisition of SARS-CoV-2 for certain sociodemographic groups. Larger studies are warranted to confirm and further explore novel pregnancy findings.

Introduction 2

The role sociodemographic and genetic factors play in susceptibility to SARS-CoV-2 transmission and 3 disease progression still remains unclear. Initial studies from Italy, Spain, China and Denmark have 4 implied that, in contrast to blood type O, those individuals with blood type A were associated with an 5 increased vulnerability to SARS-CoV-2 1, 2, 3 . However, more recent research conducted in the United one of the first investigations to examine the relationship between pregnancy status and disease 11 acquisition.

14 This IRB approved, case-controlled study was conducted at the Jefferson University Hospitals located in New 

There was a subgroup analysis focused on women of childbearing age and pregnancy status.

Association amongst patient characteristics with blood type, SARS-CoV-2 test positivity, and mortality were 24 analyzed using Chi squared and Fisher's exact test for discrete variables while the continuous variables 25 were analyzed with ANOVA and T-test. Logistic regression analysis was used to estimate the association 26 of blood type with testing positive for SARS-CoV-2 and mortality, adjusting for baseline characteristics 27 that were associated with blood type including age, race, and gender. A subgroup analysis was conducted 28 on women of childbearing age (13-49). These analyses were performed using SAS v9.4 (SAS Institute,

Cary, NC). All p-values are two-sided and p-values less than 0.05 were considered significant.

Odds ratios (OR) were utilized and confidence intervals (CI) were set at 95%. In the subgroup of women of childbearing age, the associations of age, race, blood type, and pregnancy 79 status with COVID positivity was examined (Table 2 ). Race and pregnancy status were associated with 80 COVID positivity (p<0.001 in both cases). Race showed an association with 81 pregnancy status in women who were COVID + (p<0.001) and COVID -(p<0.001). Likewise COVID 82 positivity was associated with race in both non pregnant (p<0.001) and pregnant (p<0.001) patients.

Pregnancy status was associated with categorical age in women who were both COVID + (p<0.001) and

84 COVID -(p<0.001). For women who were not pregnant, COVID positivity was associated with age 85 (p=0.023). In a multivariable analysis adjusted for age and race (Figure 3) , none of the blood types were 86 associated with increased positivity when compared with blood type O. As in the overall study 87 population, black race was associated with increased testing positivity when compared with white race 

Association between ABO blood groups and risk of SARS-CoV-2 pneumonia

Reduced prevalence of SARS-CoV-2 Infection in 196 197 ABO blood group O

Blood type and outcomes in patients with COVID-19

Associations between blood type and COVID-19 infection, 201 intubation and death

ABO blood types and COVID-203 19; spurious, anecdotal, or truly important relationships: a reasoned review of available data

Association of sociodemographic factors and blood group 206 with risk of COVID in a U.S. population

More research is warranted to support this finding and to explore if positivity is affected by physiological, 186 social, or behavioral factors, or influenced by a combination of causes.

which the cases and controls were recruited from an in-patient setting. This has the potential to produce 171 selection bias as hospital patients may have characteristics different than the general, non-hospitalized community.

Immunization status was not a factor in this study as vaccinations were not available to the general public,

including our study population, until April of 2021.Therefore, immunization status is not relevant,

nor considered a limitation for this study. 

This study is the first to identify a correlation between pregnancy status and SARS-CoV-2 positivity and 184 can add to the limited body of knowledge that exists pertaining to this population and SARS-CoV-2.