Demographic and co-morbidity characteristics of patients tested for SARS-CoV-2 from March 2020 to January 2022 in a national clinical research network: results from PCORnet®

Background Prior studies have documented differences in the age, racial, and ethnic characteristics among patients with SARS-CoV-2 infection. However, little is known about how these characteristics changed over time during the pandemic and whether racial, ethnic, and age disparities evident early in the pandemic were persistent over time. This study reports on trends in SARS-CoV-2 infections among U.S. adults from March 1, 2020 to January, 31 2022, using data from electronic health records. Methods and Findings We captured repeated cross-sectional information from 43 large healthcare systems in 52 U.S. States and territories, participating in PCORnet®, the National Patient-Centered Clinical Research Network. Using distributed queries executed at each participating institution, we acquired information for all patients ≥ 20 years of age who were tested for SARS-CoV-2 (both positive and negative results), including care setting, age, sex, race, and ethnicity by month as well as comorbidities (assessed with diagnostic codes). During this time period, 1,325,563 patients had positive (13% inpatient) and 6,705,868 patients had negative (25% inpatient) viral tests for SARS-CoV-2. Disparities in testing positive were present across racial and ethnic groups, especially in the inpatient setting. Compared to White patients, Black or African American and other race patients had relative risks for testing positive of 1.5 or greater in the inpatient setting for 12 of the 23-month study period. Compared to non-Hispanic patients, Hispanic patients had relative risks for testing positive in the inpatient setting of 1.5 or greater for 16 of 23. Ethnic and racial differences were present in emergency department and ambulatory settings but were less common across time than in inpatient settings. Trends in infections by age group demonstrated higher test positivity for older patients in the inpatient setting only for most months, except for June and July of 2020, April to August 2021, and January 2022. Comorbidities were common, with much higher rates among those hospitalized; hypertension (38% of patients SARS-CoV-2 positive vs. 29% for those negative) and type 2 diabetes mellitus (22% vs. 13%) were the most common. Conclusion and Relevance Racial and ethnic disparities changed over time among persons infected with SARS-CoV-2. These trends highlight potential underlying mechanisms, such as poor access to care and differential vaccination rates, that may have contributed to greater disparities, especially early in the pandemic. Monitoring data on characteristics of patients testing positive in real time could allow public health officials and policymakers to tailor interventions to ensure that patients and communities most in need are receiving adequate testing, mitigation strategies, and treatment. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded through a cooperative agreement to the Task Force for Global Health, through the US Centers for Disease Control and Prevention: COVID-19 Electronic Healthcare Data Initiative. Each of the institutions received funding through this agreement. Several US Centers for Disease Control and Prevention (CDC) investigators are co-authors on this manuscript, and the CDC provided clearance for this manuscript. The Clinical Research Networks and Coordinating Center reported in this publication are Network Partners in PCORnet, the National Patient-Centered Clinical Research Network. PCORnet has been developed with funding from the Patient-Centered Outcomes Research Institute (PCORI). The Network Partners’ participation in PCORnet is funded through the following PCORI Awards: Coordinating Center (PCORI-CC2-Duke-2016) ADVANCE (RI-CRN-2020-001) CaPriCORN (RI-CRN-2020-002) GPC (RI-CRN-2020-003) HealthCore (HP-1510-32545) Insight (RI-CRN-2020-004) OneFlorida (RI-CRN-2020-005) PaTH (RI-CRN-2020-006) PEDSnet (RI-CRN-2020-007) REACHnet (RI-CRN-2020-008) and, STAR (RI-CRN-2020-009). The funder provided support in the form of salaries or stipends for all authors. As the funding organization of the network infrastructure for PCORnet, PCORI participates in discussions and high-level decision-making about the network and its strategic priorities. With this participation, PCORI provided support and approval for the initiative to alter the PCORnet infrastructure and support queries related to COVID-19. However, PCORI but had no specific role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study has been exempted from human subjects review because it is public health surveillance conducted under the direction of a public health authority. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes This data was captured using distributed queries of healthcare system clinical data. We only have aggregate data and not the source data available for this publication. All relevant data for this publication is included in the manuscript itself. Requests for further data relevant to this publication are available through the PCORnet Front Door: . * EHR : electronic health record CDM : Common Data Model ETL : extract-transfer-load procedure to move data from a clinical data warehouse to the PCORnet Common Data Model Arrhyth : arrhythmia CAD : coronary artery disease CHF : congestive heart failure CKD : chronic kidney disease Chron pulm : chronic pulmonary disease Coag : Coagulopathy DM2 : type 2 diabetes mellitus HTN : hypertension Mental : mental health disorder Amb : ambulatory care setting ED : emergency department Inpt : inpatient Vent : inpatient with procedure codes indicating use of mechanical ventilation conv plasma : convalescent plasma dex : dexamethasone HCQ : hydroxychloroquine remdes : remdesivir steroids : corticosteroids other than dexamethasone tocili : tocilizumab