Abstract
Outpatients can be at heightened risk of COVID-19 due to interaction between existing non-communicable diseases in outpatients and infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study measured the magnitude of COVID-19 prevalence and explored related risk characteristics among adult outpatients visiting medicine clinics within a New York state-based tertiary hospital system. Data were compiled from 63,476 adult patients visiting outpatient medicine clinics within a New York-area hospital system between March 1, 2020, and August 28, 2020. The outcome was a clinical diagnosis of COVID-19. Crude and adjusted prevalence ratios (PR) of a COVID-19 were analyzed using univariable and multivariable Poisson regression with robust standard errors. The prevalence of COVID-19 was higher among these outpatients (3.0%) than in the total population in New York State (2.2%) as of August 28, 2020. Multivariable analysis revealed adjusted prevalence ratios significantly greater than one for male sex (PR=1.10), age 40 to 64 compared to <40 (PR=1.19), and racial/ethnic minorities in comparison to White patients (Hispanic: PR=2.76; Black: PR=1.89; and Asian/others: PR=1.56). Nonetheless, factors including the advanced age of ≥65 compared to <40 (PR=0.69) and current smoking compared to non-smoking (PR=0.60) were related to significantly lower prevalence. Therefore, the prevalence of COVID-19 in outpatients was higher than that of the general population. The findings also enabled hypothesis generation that routine clinical measures comprising sex, age, race/ethnicity, and smoking were candidate risk characteristics of COVID-19 in outpatients to be further verified by designs capable of assessing temporal association.
Highlights
The profound effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted from the intersection of a highly infectious virus with a pre-existing pandemic of non-communicable diseases (NCDs) in adults and the elderly and from potentially greater risk of viral exposure among vulnerable demographic groups
Studies devoted to understanding these potential risk characteristics of COVID-19 in the domain of outpatients who have an array of existing non-communicable diseases and are plausibly at increased risk of the infection and adverse outcomes are still scarce
Hospital-based studies previously examining these risk characteristics have been mainly conducted in inpatient populations, precluding the generalizability of findings to the outpatients who should be the targeted group for early prevention before infection and severe consequences of COVID-19
Summary
The profound effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted from the intersection of a highly infectious virus with a pre-existing pandemic of non-communicable diseases (NCDs) in adults and the elderly and from potentially greater risk of viral exposure among vulnerable demographic groups. Studies devoted to understanding these potential risk characteristics of COVID-19 in the domain of outpatients who have an array of existing non-communicable diseases and are plausibly at increased risk of the infection and adverse outcomes are still scarce. Hospital-based studies previously examining these risk characteristics have been mainly conducted in inpatient populations, precluding the generalizability of findings to the outpatients who should be the targeted group for early prevention before infection and severe consequences of COVID-19. Investigation in outpatient settings across different countries would provide additional evidence for evaluating the suggested relationship
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