space traveling warriors tier list : Clinical risk, sociodemographic factors, and SARS-CoV-2 infection over time in Ontario, Canada

A description of the number of study participants and the reasons for inclusion and exclusion are summarized in Fig. 2 supplementary. Overall, 3,167,753 eligible community patients underwent RT-PCR testing for SARS-CoV-2 infection between January 1 and December 31, 2020, of which 142,814 (4.5%) were test positive. confirmed (Table 1 and Supplementary Table 2). The weekly number and rate of community-dwelling individuals testing positive for SARS-CoV-2 by age group are shown in Fig. 1. The weekly number of community-dwelling individuals tested for SARS-CoV-2 and the share of tests that were positive, stratified by age group, is shown in Fig. 4 supplementary. During the first wave, the peak number and proportion of individuals with laboratory-confirmed SARS-CoV-2 infection occurred during the week beginning April 12, 2020, three weeks after a province-wide lockdown, which reflects the standard latency period to measure the impact of public health measures on infection rates (Supplementary Fig. 1)36.

Table 1 Baseline characteristics of community patients with and without SARS-CoV-2 infection during the first wave of the pandemic in Ontario, Canada.
figure 1

Weekly number and rate of community-dwelling individuals with SARS-CoV-2 infection stratified by age group during 2020, prior to (ONE Weeks from January 1st to April 12th) and beyond (B Weeks from April 19 to June 7 and Ç Weeks from June 14 to December 27) the peak of the first wave of the pandemic in Ontario, Canada. Time represented by the start of the calendar week with the weeks from January 1st to March 8th consolidated, due to low initial infection counts. Age groups: 18–45 years (dark green); 45–65 years (light green); 65–75 years (light blue); 75–85 years (pink); 85 years or older (orange). The proportion of weekly counts attributable to an age group is represented in each column with the percentage indicated in each section. The peak of the first wave of the pandemic in terms of community infections, using the test positivity proxy in Ontario, correlated with the week of April 12, 2020. People aged 75 and over are matched to suppress small cells for weeks of 1 January to March 8 and 7 June in accordance with ICES re-identification risk assessment procedures.

Baseline sociodemographic and clinical characteristics among community-dwelling individuals with and without SARS-CoV-2 infection during the first wave (i.e., the first half of 2020) are presented in Table 1. Compared to individuals without infection by SARS-CoV-2, the community Residents with SARS-CoV-2 infection were generally younger, more often male, immigrants, and resided in low-income, large, urban, and racially/ethnically diverse communities. This trend continued until the end of 2020 (Supplementary Table 2). In addition, individuals with SARS-CoV-2 infection had higher rates of diabetes initially, but conversely, had lower rates of most clinical comorbidities and lower rates of recent hospitalization or emergency room visits, which remained. consistent until the end of 2020.

Independent predictors of laboratory-confirmed SARS-CoV-2 infection among community-tested individuals are presented in Table 2. Results are stratified in the period before and immediately after the peak of the first wave of the pandemic in the province, as well as the remainder of 2020, given the detection of significant heterogeneity in the risk of SARS-CoV-2 infection by age over time (P-interaction < 0.0001). During the period leading up to the peak of the first wave of the pandemic, the probability of SARS-CoV-2 infection progressively increased in all age groups (age 45–65, OR 1.30, 95% CI 1.24–1, 37; age 65–75, OR 1.38, 95% CI 1.26–1.51; age 75–85, OR 1.46, 95% CI 1.30–1.63; age 85 or older, OR 1.60, 95% CI 1.41–1.81) compared to younger individuals aged between 18 and 45 years. Other independent risk factors for SARS-CoV-2 infection included male sex (OR 1.45, 95% CI 1.31–1.60), residing in the lowest income quintile of the neighborhood (OR 1.09, CI 1.09, 95% 1.01–1.17), residing in more racially/ethnically diverse communities (OR per 1% increase in regional racial/ethnic diversity 1.02, 95% CI 1.01–1.03), immigration for Canada (OR 1.53, 95% CI 1.45–1.61), frailty (OR 1.31, 95% CI 1.01 –1.25), hypertension (OR 1.10, 95% CI 1.04–1.17) and diabetes (OR 1.12, 95% CI 1.05–1.20).

Table 2 Predictors of SARS-CoV-2 infection before (weeks January 1 to April 12, 2020) and after (weeks April 19 to June 7, 2020; weeks June 14 to December 27, 2020) 2020) the peak of the first wave of the pandemic among individuals in the community in Ontario, Canada.

Immediately after the peak of the first wave of the pandemic, the probability of laboratory-confirmed SARS-CoV-2 infection across all age groups in community-dwelling individuals reversed (Supplementary Fig. 4). Thereafter, older individuals aged ≥85 years had the lowest likelihood of SARS-CoV-2 infection (Table 2), with a progressive increase in infection risk as age decreased compared with individuals aged ≥85 years. years (age 75–85, OR 1.11, 95% CI 0.97–1.28; age 65–75, OR 1.23, 95% CI 1.08–1.40; age 45–65, OR 1.43, 95% CI 1.27–1.62; and age 18–45, OR 1.58, 95% CI 1.40–1.80). In addition, there was a progressive increase in the risk of SARS-CoV-2 infection in all the lowest income quintiles of the neighborhood compared to the highest quintile (quintile 1, OR 2.01, 95% CI 1.87–2 .16; quintile 2, OR 1.53, 95% CI 1.43–1.65; quintile 3, OR 1.46, 95% CI 1.36–1.57; quintile 4, OR 1.27, CI 95% 1.17–1.37). Other independent risk factors included male gender (OR 1.67, 95% CI 1.52–1.83), residing in more racially/ethnically diverse communities (OR per 1% increase 1.05, 95% CI 1, 03–1.06), immigration to Canada (OR 1.82, 95% CI 1.75–1.90), history of hypertension (OR 1.07, 95% CI 1.01–1.12) and history of diabetes (OR 1.32, 95% CI 1.24–1.40).

Results up to the end of 2020 are reported in Table 2. Independent risk factors continued to be younger individuals (18 to 45 years, OR 1.09, 95% CI 1.03 to 1.14), who had the highest probabilities of SARS-CoV-2 infection compared with older age groups (age 66–75, OR 0.87, 95% CI 0.83–0.92; and age 76–85, OR 0.85, CI 0.85 95% 0.81–0.90). There continued to be a progressive increase in the risk of infection in the lower income quintiles of the neighborhood (quintile 1, OR 1.64, 95% CI 1.60–1.67; quintile 2, OR 1.45, 95% CI 1, 42–1.48; quintile 3, OR 1.39, 95% CI 1.36–1.42; quintile 4, OR 1.17, 95% CI 1.15–1.19). Other independent risk factors included being male (OR 1.24, 95% CI 1.20–1.27), residing in more racially/ethnically diverse communities (OR per 1% increase 1.04, 95% CI 1, 03–1.05), immigration to Canada (OR 1.99, 95% CI 1.96–2.01), history of hypertension (OR 1.08, 95% CI 1.07–1.10) and history of diabetes (OR 1.33, 95% CI 1.30–1.36).

The absolute and relative risk of laboratory-confirmed SARS-CoV-2 infection among community-dwelling individuals according to the number of independent risk factors identified above (e.g., age category, male gender, residing in a low-income neighborhood income, Canadian immigrant status, hypertension, diabetes and, prior to the peak of the pandemic, a history of frailty), degree of regional racial/ethnic diversity, and time period are shown in Fig. 2 and Table 3. Prior to the peak of the pandemic, SARS -CoV-2 infection rates were generally higher in communities with greater racial/ethnic diversity and among individuals with a greater number of risk factors, so that individuals who living in the most racially/ethnically diverse communities with no other risk factors had a similar rate of infection as individuals living in the least racially/ethnically diverse communities with 3 or more risk factors (Fig. 2a). Individuals with 1, 2, or ≥ 3 risk factors had progressively greater odds of SARS-CoV-2 infection compared with individuals without risk factors in regions of racial/ethnic diversity.

Figure 2
Figure 2

SARS-CoV-2 infection rates by number of risk factors and degree of regional racial/ethnic diversity, before (ONE Weeks from January 1 to April 12, 2020) and beyond (B Weeks from April 19 to June 7, 2020 and Ç Weeks from June 14 to December 27, 2020) the peak of the first wave of the pandemic in Ontario, Canada. Subjects were classified according to the number of potential risk factors present. Risk factors prior to the first wave were: male gender, age > 45 years, lowest income quintile of the neighborhood, Canadian immigrant, history of frailty, hypertension and diabetes; after the first wave: male, age < 85 years, neighborhood income quintiles 1-4, Canadian immigrant, hypertension and diabetes. The region was categorized by racial/ethnic diversity rate quartiles in the community.

Table 3 SARS-CoV-2 infection rates and odds ratios by number of risk factors and degree of regional racial/ethnic diversity, before (weeks January 1 to April 12, 2020) and after (weeks 19 April to June 7, 2020; weeks June 14 to December 27, 2020) the peak of the first wave of the pandemic among individuals in the community in Ontario, Canada.

After the peak of the first wave of the pandemic in mid-April and continuing through the remainder of 2020, infection rates declined in Ontario, but there was less impact in regions with higher degrees of racial/ethnic diversity. Furthermore, while the accumulation of more risk factors remained associated with a higher risk of SARS-CoV-2 infection in the most racially/ethnicly diverse communities, risk factors now included all age groups < 85 years (Fig. 2b). and c; Table 3). Immediately after the peak of the first wave, individuals living in the most racially/ethnically diverse communities with 2, 3, or ≥ 4 risk factors had ORs of 1.89, 3.07, and 4.73 for SARS-CoV- 2 compared to lower risk individuals in their community with 0-1 risk factors. In contrast, in communities with less racial/ethnic diversity, there was little or no gradient in infection rates across risk strata. For the remainder of 2020, although absolute infection rates increased in all four quartiles compared to immediately after the peak of the first wave, the ORs for SARS-CoV-2 infection among individuals living in the most racially/ethnic communities several with 2, 3, or ≥ 4 risk factors remained significantly elevated at 1.66, 2.48, and 3.70, with little gradient in infection rates across risk strata among the least racially/ethnically diverse communities.

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