VA COVID-19 Cohort

The Veterans COVID-19 cohort was created to study SARS-CoV-2 and associated adverse health outcomes. It includes >220,000 Veterans who have tested positive and about a million who tested negative. The cohort includes integrated inpatient and outpatient records. Real time analyses of mortality and other clinical endpoints have been published using this cohort during the pandemic. The Veterans Administration COVID-19 (VACo) 30 day mortality Index was developed using this cohort. The VACO Index reproducibly identified individuals at substantial risk of COVID-19 mortality who might consider continuing social distancing, despite relaxed state and local guidelines. Between February 8 and July 22, 2020, 254,595 individuals were tested and 16,317 tested positive for COVID -19.

While individuals from minority backgrounds were more likely to test positive (Black vs White: OR 1.93, 95% CI 1.85-2.01, p<0.0001; Hispanic vs White: OR 1.84, 95% CI 1.74-1.94, p<0.0001), 30-day mortality did not differ by race/ethnicity (Black vs White: OR 0.97, 95% CI 0.80-1.17, p=0.74; Hispanic vs White: OR 0.99, 95% CI 0.73-1.34, p=0.94). The disparity between Black and White individuals in testing positive for Covid-19 was stronger in the Midwest (OR 2.66, 95% CI 2.41-2.95, p<0.0001) than the West (OR 1.24, 95% CI 1.11-1.39, p<0.0001). The disparity in testing positive for COVID-19 between Hispanic and White individuals was consistent across region, calendar time, and outbreak pattern. Our paper was the first national study to demonstrate that Black and Hispanic individuals are experiencing an excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live or receive care. This work, published in PLOS Medicine, demonstrates access to national VA data, ability to analyze real time data on COVID-19, and understanding of temporal and regional differences in infection and mortality rates.