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 , * Open Modal 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 Authors Info & Affiliations
The Open Respiratory Medicine Journal 31 Aug 2022 RESEARCH ARTICLE DOI: 10.2174/18743064-v16-e2207130



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.

Keywords: Altitude, COVID-19, Gastrointestinal, Latitude, Respiratory, Symptoms.
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