Does home COVID-19 testing bias COVID-19 vaccine effectiveness estimates?

IF 4.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine Pub Date : 2025-09-11 DOI:10.1016/j.amepre.2025.108096

Mary Patricia Nowalk, G K Balasubramani, Helen D'Agostino, Richard K Zimmerman, Arnold S Monto, Emily T Martin, Huong Q Nguyen, Manjusha Gaglani, Mufaddal Mamwala, Sara Tartof, Bruno J Lewin, Karen Wernli, Brianna Wickersham, H Keipp Talbot, Carlos G Grijalva, Jessie R Chung, Brendan Flannery

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引用次数: 0

Abstract

Introduction: COVID-19 home testing became widely available in early 2021. Care seeking for acute respiratory illness (ARI), and COVID-19 vaccine effectiveness (VE) estimates may be affected by home testing.

Methods: In a test-negative case-control study, between January-May 2022, U.S. Flu VE Network outpatients were asked about their home COVID-19 testing before seeking care for ARI and were laboratory tested for SARS-CoV-2. Associations among home testing, care seeking and COVID-19 VE were assessed using multivariable logistic regression.

Results: Among 2,614 enrollees, home COVID-19 testing was significantly associated with current (≤6 months) COVID-19 vaccination (adjusted odds ratio (aOR=1.70; 95%CI=1.19-2.42); cough (aOR=1.69; 1.22-2.34) and having a college degree or higher (aOR=1.67; 1.37-2.03) and negatively associated with a prior positive COVID-19 test. COVID-19 illness was associated with cough (aOR=3.07; 2.04-4.61), contact with a COVID-19 case (aOR=2.41; 1.93-3.0), home testing (aOR=1.87; 1.53-2.29) and negatively associated with a prior positive COVID-19 test. In unadjusted modeling with only the association between current vaccination and COVID-19 infection, the OR was 0.77 (95% CI=0.66, 0.92); adjusting for patient race/ethnicity, age, days from onset to enrollment, prior COVID-19 illness and study site, the aOR was 0.65 (0.55, 0.78); estimated VE=35% (95%CI=22%-45%). Adding home testing to this adjusted model, VE was 37% (95%CI=13%-46%). Among patients who home tested, VE was 31% (13%-46%) versus 43% (24%-57%) among patients who did not.

Conclusion: Patients reporting home testing for COVID-19 before seeking outpatient care for ARI differed from patients not using home tests, which could affect estimates of COVID-19 VE in some populations.

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家庭COVID-19检测是否会影响COVID-19疫苗有效性评估？

2019冠状病毒病家庭检测于2021年初广泛普及。急性呼吸道疾病（ARI）的求诊和COVID-19疫苗有效性（VE）估计可能受到家庭检测的影响。方法：在2022年1月至5月期间，在一项检测阴性的病例对照研究中，美国流感VE网络门诊患者在寻求ARI治疗之前被问及他们的家庭COVID-19检测，并进行了SARS-CoV-2实验室检测。采用多变量logistic回归评估家庭检测、求诊与COVID-19 VE之间的关系。结果：在2,614名入组者中，家庭COVID-19检测与当前（≤6个月）COVID-19疫苗接种显著相关(调整优势比（aOR=1.70; 95%CI=1.19-2.42）；咳嗽（aOR=1.69; 1.22-2.34）、大学及以上学历（aOR=1.67; 1.37-2.03），且与既往COVID-19检测阳性呈负相关。COVID-19疾病与咳嗽（aOR=3.07; 2.04-4.61）、接触COVID-19病例（aOR=2.41; 1.93-3.0）、家庭检测（aOR=1.87; 1.53-2.29）相关，与既往COVID-19检测阳性呈负相关。在未调整的模型中，仅存在当前疫苗接种与COVID-19感染之间的关联，OR为0.77 (95% CI=0.66, 0.92)；调整患者种族/民族、年龄、发病至入组天数、既往COVID-19疾病和研究地点后，aOR为0.65 (0.55,0.78)；估计VE=35% （95%CI=22%-45%）。将家庭测试添加到调整后的模型中，VE为37% （95%CI=13%-46%）。在进行家庭检测的患者中，VE为31%(13%-46%)，而未进行家庭检测的患者为43%（24%-57%）。结论：报告在寻求ARI门诊治疗前进行COVID-19家庭检测的患者与未进行家庭检测的患者不同，这可能会影响某些人群中COVID-19 VE的估计。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Preventive Medicine 医学-公共卫生、环境卫生与职业卫生

CiteScore

8.60

自引率

1.80%

发文量

395

审稿时长

32 days

期刊介绍： The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women''s health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.