Ethnic minorities, patients with cancer at higher risk for COVID-19, app-based study shows
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Ethnic minorities and people with cancer, particularly those receiving chemotherapy or immunotherapy, demonstrated increased risk for COVID-19, according to results of a study based on self-reported data collected through a smartphone app.
The association of COVID-19 with historically underrepresented individuals could not be completely explained by other known risk factors for the virus or sociodemographic characteristics, researchers noted.
“This study uses a smartphone app to allow individuals to self-report a range of factors relevant to COVID-19 epidemiologic research,” David Drew, PhD, instructor of medicine at Massachusetts General Hospital, said during a presentation at American Association for Cancer Research Virtual Meeting: COVID-19 and Cancer. “Through the use of this smartphone app, we were able to rapidly develop a large prospectively collected longitudinal data set. Beyond the general public, we also recruited individuals in ongoing cohort studies and clinical trials.”
The COVID-19 pandemic and response have highlighted the need for real-time population-level data, particularly among patients with cancer and historically underrepresented groups, according to Drew and colleagues. Smartphone apps help facilitate the collection of self-reported data that can be redeployed rapidly to help construct a public health response.
Researchers launched the COVID Symptom Study app, a real-time epidemiological tool, on March 24. The app, which has been used by almost 4 million people in the United States, United Kingdom and Sweden, allows users to self-report health status, comorbidities, demographics and key risk factors for COVID-19 on a daily basis.
Data collected through May 25 enabled researchers to analyze the association of cancer and race with COVID-19 prevalence, adjusting for age, sex, comorbidities and risk factors for infection through logistic regression models.
The investigators documented 155 self-reported cases of COVID-19 among 23,266 patients with cancer and 10,249 cases among 1,784,293 individuals without cancer.
Results showed that, compared with individuals without cancer, patients with cancer had increased risk for COVID-19 (adjusted OR [aOR] = 1.6; 95% CI, 1.36-1.88). The strongest associations occurred among participants aged older than 65 years compared with younger participants (P for interaction < .001) and among males (aOR = 1.71; 95% CI, 1.36-2.15) compared with females (aOR = 1.43; 95% CI, 1.14-1.79; P for interaction = .02).
Receipt of chemotherapy or immunotherapy led to a more than twofold increased risk for COVID-19 (aOR = 2.22; 95% CI, 1.68-2.94) and for COVID-19-related hospitalization (aOR = 2.47; 95% CI, 2.22-2.76).
A separate analysis revealed 8,990 self-reported cases of positive COVID-19 testing among 2,304,472 white participants; 93 cases among 19,498 Hispanic participants; 204 among 19,498 Black participants; 608 among 64,429 Asian participants; and 352 among 65,046 mixed race or other racial minorities.
Compared with white participants, ORs for reporting a positive COVID-19 test for racial minorities ranged from 1.44 for participants of mixed or other races to 2.59 for Black participants, according to the abstract.
After accounting for risk factors for infection, comorbidities and sociodemographic characteristics, ORs for reporting a positive COVID-19 test were 1.37 (95% CI, 1.09-1.72) for Hispanic participants, 1.42 (95% CI, 1.23-1.64) for Black participants, 1.44 (95% CI, 1.33-1.57) for Asian participants and 1.18 (95% CI, 1.06-1.32) for participants of mixed race or other racial minorities.
“The app allows us to be nimble and adaptable to address emerging questions during a rapidly evolving pandemic,” Drew said. “We are aware that our study may not generalizable because the population is limited to people who have smartphones. We hope to better address this issue moving forward.”
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Drew D, et al. Abstract S09-01. Presented at: AACR Virtual Meeting: COVID-19 and Cancer; July 20-22, 2020.
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