CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

924

COVID-19 Symptoms, Vaccination and Long COVID Between Cancer Survivors and the US General Population Jincong Q. Freeman 1 , Victoria Umutoni 2 , Xinyi Li 1 , Olivia Zou 3 , Ted O. Akhiwu 4 1 The George Washington University, Washington, DC, USA, 2 University of Chicago, Chicago, IL, USA, 3 Basis Independent Silicon Valley, San Jose, CA, USA, 4 MedStar Health, Washington, DC, USA Background: COVID-19 can have lasting symptoms that may vary in different populations. Cancer survivors face many health challenges and may be more vulnerable to COVID-19. This study examined differences in COVID-19 symptoms, vaccination status, and long COVID between cancer survivors and the general population in the US. Methods: We conducted a secondary data analysis of the 2022 National Health Interview Survey that used multi-stage probability sampling, accounting for complex survey design. Adults aged ≥18 years with a cancer history were cancer survivors, and the general population included those without a cancer history. Long COVID was defined as having any symptoms lasting ≥3 months that were absent before having SARS-CoV-2 or COVID-19. Participants were also asked to describe their level of symptom severity and whether they received ≥1 dose of COVID-19 vaccination. Weighted proportions (95% CIs) were compared using Rao-Scott Chi-squared tests. Weighted logistic regression was used to assess differences in long COVID between cancer survivors and the general population, controlling for sociodemographics and vaccination status. Adjusted odds ratios (AOR, 95% CI) were computed. Results: The unweighted sample was 8,936 (weighted n=89,331,130, mean age=44 years); of whom, 7.6% (95% CI: 7.0-8.2%) were cancer survivors and 63.4% identified as White, followed by 19.2% as Hispanic, 9.6% as Black, 4.8% as Asian, and 3.0% as Other. Compared with the general population, significantly higher proportions of cancer survivors experienced severe COVID-19 symptoms (17.9% [95% CI: 15.4-20.4%] vs. 14.3% [95% CI: 13.5 15.2%], p =.019) (Figure) and received a COVID-19 vaccine (88.6% [95% CI: 87.3-89.9%] vs. 78.6% [95% CI: 77.8-79.5%], p <.001). Overall, 19.7% (95% CI: 18.7-20.7%) experienced long COVID. The weighted percentage of long COVID was significantly higher in cancer survivors than in the general population (23.6% [95% CI: 20.3-27.0%] vs. 19.4% [95% CI: 18.3-20.4%], p =.009). After covariate adjustment, the odds of long COVID between the two populations were not statistically significant (AOR 1.05, 95% CI: 0.85-1.31, p =.635). Conclusions: In this US national sample, cancer survivors experienced more severe COVID-19 symptoms than the general population, with no differences in long COVID. Strategies are needed to address COVID-19 symptom severity in cancer survivors while ensuring equitable COVID-19 care access. Future research should also consider other factors beyond cancer history when assessing long COVID.

obesity, and hypoxia. Anosmia/dysgeusia was associated with prior COVID admission, but wide confidence intervals reflected few charted diagnoses. Conclusions: Manifestations of Long COVID at population scale as defined by the National Academies are detectable as part of routine symptoms and clinical diagnoses in the EHR after admissions for COVID-19, compared with all other hospital admissions. Some features of Long COVID are not well coded in the EHR. Completeness of COVID-19 Outcomes Among People With HIV Receiving Care in New York City in 2020 Jenny Shen 1 , Keith M. Sigel 2 , Joseph P. McGowan 3 , Daniel Bertolino 4 , Kathryn Anastos 5 , Uriel R. Felsen 5 , Denis Nash 1 , Viraj V. Patel 5 , Mckaylee M. Robertson 1 , Miguel A. Hernan 6 , Sarah L. Braunstein 4 , Heidi E. Jones 1 , David B. Hanna 5 1 CUNY School of Public Health, New York, NY, USA, 2 Mount Sinai Health System, New York, NY, USA, 3 Northwell Health, New York, NY, USA, 4 New York City Department of Health and Mental Hygiene, Long Island City, NY, USA, 5 Albert Einstein College of Medicine, Bronx, NY, USA, 6 Harvard TH Chan School of Public Health, Boston, MA, USA Background: Many early COVID-19 outcome studies were based exclusively on electronic health record (EHR) data from single health systems. However, many people in 2020 who would have ordinarily received care in the same system experienced outcomes at other hospitals or at home – 2 common scenarios when COVID-19 temporarily transformed usual practice. We assessed completeness of COVID-19 outcomes among people with HIV (PWH) receiving HIV care in 3 New York City health systems, comparing EHR data alone to the gold standard of public health surveillance data. Methods: We included adult (18+) PWH treated with antiretroviral therapy from 1/1/2019-3/1/2020 in the Montefiore, Mount Sinai and Northwell health systems. We obtained PCR-confirmed COVID-19 infections, hospitalizations (via diagnosis codes), ICU admissions and all-cause deaths from health system EHRs through 12/31/2020, before COVID-19 vaccines were widely available. We linked data with the New York City HIV and COVID-19 Surveillance Registries, which contain city-wide data on legally mandated reporting of HIV, COVID-19 and deaths. We compared numbers of COVID-19 outcomes identified between data sources. To assess potential bias when limiting analyses of COVID-19 outcomes to EHR data alone, we compared associations of selected characteristics with COVID-19 outcomes by source. Results: Among 19833 PWH (73% men, 42% Black, 39% Latino, 16% white, median age 53), we identified 1372 (7%) COVID-19 infections, 435 (2%) hospitalizations, 70 (0.3%) ICU admissions and 460 deaths (2%) (Table). Using EHR data alone resulted in a 3-fold underestimation of COVID-19 infections, hospitalizations and ICU admissions and 5-fold underestimation of all-cause mortality. Among those who died, younger PWH were more likely to be missing from EHR after adjusting for site, race/ethnicity, sex, HIV transmission category and HIV viral suppression. In relation to pre-COVID HIV viral suppression, the adjusted odds ratio of all-cause mortality for pre-COVID HIV viremia (200+ cp/ mL) was 1.62 (95% CI 0.96-1.70) using EHR data only and 2.20 (95% CI 1.76-2.75) using surveillance data. Adjusted associations of race/ethnicity differed by source across all 4 COVID-19 outcomes. Conclusions: In 2020, analyses limited to EHR severely underestimated COVID-19 outcomes and resulted in important biases in outcome estimates and measures of association. Interpretation of estimates from EHR-based studies during public health emergencies should require careful consideration of ascertainment bias. The figure, table, or graphic for this abstract has been removed.

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Poster Abstracts

925

A Population-Based Study of Functional Disability, COVID-19 Symptoms, and Long COVID Among US Adults Jincong Q. Freeman 1 , Xinyi Li 1 , Victoria Umutoni 2 , Ted O. Akhiwu 3 , Heather J. Hoffman 1 1 The George Washington University, Washington, DC, USA, 2 University of Chicago, Chicago, IL, USA, 3 MedStar Health, Washington, DC, USA Background: COVID-19 can have long-term effects on health. People with disabilities may bear a heavier burden of COVID-19 and be more susceptible to severe and prolonged symptoms. This study assessed relationships between functional disability, COVID-19 symptoms, and long COVID in US adults. Methods: We obtained population-based data from the 2022 National Health Interview Survey using multistage probability sampling to interview adults aged ≥18 years. Any disability (yes/no) was defined by the Washington Group Composite Disability Indicator measuring self-reported levels of difficulty in 6

CROI 2025 289