The Association of Latitude and Altitude with COVID-19 Symptoms: A VIRUS: COVID-19 Registry Analysis
Aysun Tekin1, Shahraz Qamar2, Vikas Bansal3, Salim Surani1, 4, *, Romil Singh1, Mayank Sharma1, Allison M. LeMahieu5, Andrew C. Hanson5, Phillip J. Schulte5, Marija Bogojevic3, Neha Deo6, Devang K. Sanghavi7, Rodrigo Cartin-Ceba8, Nitesh K. Jain9, Amy B. Christie10, Uluhan Sili11, Harry L. Anderson12, Joshua L. Denson13, Ashish K. Khanna14, 15, Igor Borisovich Zabolotskikh16, Abigail T. La Nou17, Murtaza Akhter18, Surapaneni Krishna Mohan19, Kenneth W. Dodd20, 21, Lynn Retford22, Karen Boman22, Vishakha K. Kumar22, Allan J. Walkey23, Ognjen Gajic3, Juan Pablo Domecq24, Rahul Kashyap1
Identifiers and Pagination:Year: 2022
E-location ID: e187430642207130
Publisher ID: e187430642207130
Article History:Received Date: 1/11/2021
Revision Received Date: 7/3/2022
Acceptance Date: 20/4/2022
Electronic publication date: 31/08/2022
Collection year: 2022
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Better delineation of COVID-19 presentations in different climatological conditions might assist with prompt diagnosis and isolation of patients.
To study the association of latitude and altitude with COVID-19 symptomatology.
This observational cohort study included 12267 adult COVID-19 patients hospitalized between 03/2020 and 01/2021 at 181 hospitals in 24 countries within the SCCM Discovery VIRUS: COVID-19 Registry. The outcome was symptoms at admission, categorized as respiratory, gastrointestinal, neurological, mucocutaneous, cardiovascular, and constitutional. Other symptoms were grouped as atypical. Multivariable regression modeling was performed, adjusting for baseline characteristics. Models were fitted using generalized estimating equations to account for the clustering.
The median age was 62 years, with 57% males. The median age and percentage of patients with comorbidities increased with higher latitude. Conversely, patients with comorbidities decreased with elevated altitudes. The most common symptoms were respiratory (80%), followed by constitutional (75%). Presentation with respiratory symptoms was not associated with the location. After adjustment, at lower latitudes (<30º), patients presented less commonly with gastrointestinal symptoms (p<.001, odds ratios for 15º, 25º, and 30º: 0.32, 0.81, and 0.98, respectively). Atypical symptoms were present in 21% of the patients and showed an association with altitude (p=.026, odds ratios for 75, 125, 400, and 600 meters above sea level: 0.44, 0.60, 0.84, and 0.77, respectively).
We observed geographic variability in symptoms of COVID-19 patients. Respiratory symptoms were most common but were not associated with the location. Gastrointestinal symptoms were less frequent in lower latitudes. Atypical symptoms were associated with higher altitude.