Risk Factors for SARS-CoV-2 Infection: a Test-negative Case-control Study with Additional Population Controls in Norway

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Jan 8

PMID 38191258

Authors

Marjut Sarjomaa

Chi Zhang

Yngvar Tveten

Hege Kersten

Harald Reiso

Randi Eikeland

Johny Kongerud

Kristine Karlsrud Berg

Carina Thilesen

Svein Arne Nordbo

Ingeborg S Aaberge

Jan Vandenbroucke

Neil Pearce

Anne Kristin Moeller Fell

Affiliations

Soon will be listed here.

Abstract

Objectives: This study aims to assess risk factors for SARS-CoV-2 infection by combined design; first comparing positive cases to negative controls as determined by PCR testing and then comparing these two groups to an additional prepandemic population control group.

Design And Setting: Test-negative design (TND), multicentre case-control study with additional population controls in South-Eastern Norway.

Participants: Adults who underwent SARS-CoV-2 PCR testing between February and December 2020. PCR-positive cases, PCR-negative controls and additional age-matched population controls.

Primary Outcome Measures: The associations between various risk factors based on self- reported questionnaire and SARS-CoV-2 infection comparing PCR-positive cases and PCR-negative controls. Using subgroup analysis, the risk factors for both PCR-positive and PCR-negative participants were compared with a population control group.

Results: In total, 400 PCR-positive cases, 719 PCR-negative controls and 14 509 population controls were included. Male sex was associated with the risk of SARS-CoV-2 infection only in the TND study (OR 1.9, 95% CI 1.4 to 2.6), but not when PCR-positive cases were compared with population controls (OR 1.2, 95% CI 0.9. to 1.5). Some factors were positively (asthma, wood heating) or negatively (hypertension) associated with SARS-CoV-2 infection when PCR-positive cases were compared with population controls, but lacked convincing association in the TND study. Smoking was negatively associated with the risk of SARS-CoV-2 infection in both analyses (OR 0.5, 95% CI 0.3 to 0.8 and OR 0.6, 95% CI 0.4 to 0.8).

Conclusions: Male sex was a possible risk factor for SARS-CoV-2 infection only in the TND study, whereas smoking was negatively associated with SARS-CoV-2 infection in both the TND study and when using population controls. Several factors were associated with SARS-CoV-2 infection when PCR-positive cases were compared with population controls, but not in the TND study, highlighting the strength of combining case-control study designs during the pandemic.

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