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Associations between blood type and COVID-19 infection, intubation, and death

The rapid global spread of the novel coronavirus SARS-CoV-2 has strained healthcare and testing resources, making the identification and prioritization of individuals most at-risk a critical challenge. Recent evidence suggests blood type may affect risk of severe COVID-19. Here, we use observational healthcare data on 14,112 individuals tested for SARS-CoV-2 with known blood type in the New York Presbyterian (NYP) hospital system to assess the association between ABO and Rh blood types and infection, intubation, and death. We find slightly increased infection prevalence among non-O types. Risk of intubation was decreased among A and increased among AB and B types, compared with type O, while risk of death was increased for type AB and decreased for types A and B. We estimate Rh-negative blood type to have a protective effect for all three outcomes. Our results add to the growing body of evidence suggesting blood type may play a role in COVID-19.

The novel Coronavirus disease (COVID-19, caused by the SARS-CoV-2 virus) has spread rapidly across the globe and has caused over 21.1 million confirmed infections and over 761,000 deaths worldwide as of August 17, 20201. Within the United States, New York suffered among the worst outbreaks during the early phases of the pandemic. As of August 22, New York City has recorded 228,144 confirmed infections and 19,014 deaths2. A number of risk factors for COVID-19 morbidity and mortality are known, including age, sex, smoking, hypertension, diabetes, and chronic cardiovascular and respiratory diseases3,4.

Recent work has demonstrated an association between ABO blood types and COVID-19 risk. Using data from Wuhan and Shenzhen, Zhao et al. found a greater proportion of A and a lower proportion of O blood types among COVID-19 patients, relative to the general populations of Wuhan and Shenzhen5. Similarly, using a meta-analysis of data from Italy and Spain, Ellinghaus et al. found6 a higher risk of COVID-19 among A and a lower risk among O blood types. Conversely, however, they estimated lower odds of mechanical ventilation for all non-O types, though the estimated odds ratios were not statistically significant at the 5% level for this outcome.

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