Clinical characteristics and comorbidities associated with SARS-CoV-2 breakthrough infection in the University of California Healthcare Systems

Michael Hogarth; Daniel John; Yuxiang Li; Jessica Wang-Rodriguez; Jaideep Chakladar; Wei Tse Li; Sanjay R Mehta; Sharad Jain; Weg M Ongkeko

doi:10.1016/j.amjms.2023.04.019

Clinical characteristics and comorbidities associated with SARS-CoV-2 breakthrough infection in the University of California Healthcare Systems

Am J Med Sci. 2023 Aug;366(2):102-113. doi: 10.1016/j.amjms.2023.04.019. Epub 2023 May 3.

Authors

Michael Hogarth¹, Daniel John², Yuxiang Li², Jessica Wang-Rodriguez³, Jaideep Chakladar², Wei Tse Li², Sanjay R Mehta⁴, Sharad Jain⁵, Weg M Ongkeko⁶

Affiliations

¹ Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
² Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
³ Department of Pathology, University of California, San Diego, La Jolla, CA, USA; Pathology Service, VA San Diego Healthcare System, San Diego, CA, USA.
⁴ Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
⁵ The University of California Davis School of Medicine, Sacramento, CA, USA.
⁶ Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA. Electronic address: rongkeko@health.ucsd.edu.

Abstract

Background: To evaluate the degree to which clinical comorbidities or combinations of comorbidities are associated with SARS-CoV-2 breakthrough infection.

Materials and methods: A breakthrough infection was defined as a positive test at least 14 days after a full vaccination regimen. Logistic regression was used to calculate aORs, which were adjusted for age, sex, and race information.

Results: A total of 110,380 patients from the UC CORDS database were included. After adjustment, stage 5 CKD due to hypertension (aOR: 7.33; 95% CI: 4.86-10.69; p<.001; power=1) displayed higher odds of infection than any other comorbidity. Lung transplantation history (aOR: 4.79; 95% CI: 3.25-6.82; p<.001; power= 1), coronary atherosclerosis (aOR: 2.12; 95% CI: 1.77-2.52; p<.001; power=1), and vitamin D deficiency (aOR: 1.87; 95% CI: 1.69-2.06; p<.001; power=1) were significantly correlated to breakthrough infection. Patients with obesity in addition to essential hypertension (aOR: 1.74; 95% CI: 1.51-2.01; p<.001; power=1) and anemia (aOR: 1.80; 95% CI: 1.47-2.19; p<.001; power=1) were at additional risk of breakthrough infection compared to those with essential hypertension and anemia alone.

Conclusions: Further measures should be taken to prevent breakthrough infection for individuals with these conditions, such as acquiring additional doses of the SARS-CoV-2 vaccine to boost immunity.

Keywords: Breakthroughs; COVID-19; Comorbidities; Vaccination.

MeSH terms

Breakthrough Infections
COVID-19 Vaccines*
COVID-19* / epidemiology
Comorbidity
Essential Hypertension
Humans
SARS-CoV-2

Substances

COVID-19 Vaccines

Supplementary concepts

COVID-19 breakthrough infections