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Original article
Susceptibility and risk of SARS-COV-2 infection among middle-aged and older adults in Tarragona area, Spain
Susceptibilidad y riesgo de infección por SARS-CoV-2 en adultos mayores de 50 años en el área de Tarragona
Eva M. Satué-Graciaa,b,
Corresponding author
esatue.tgn.ics@gencat.cat

Corresponding author.
, Angel Vila-Córcolesa,b, Cinta de Diego-Cabanesc, Angel Vila-Rovirab, Cristina Torrente-Fragad, Frederic Gómez-Bertomeue, Imma Hospital-Guardiolaf, Olga Ochoa-Gondarb,g, Francisco Martín-Lujána,b
a Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Unitat de Suport a la Recerca (USR), Camí de Riudoms, 53-55, 43202 Reus (Tarragona), Spain
b Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAP J Gol), Gran Via Corts Catalanes, 587, 08007 Barcelona, Spain
c Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Centre d’Alta Resolució (CAR) Salou, Tarragona, Spain
d Technology and Informatic Department Camp de Tarragona, Institut Català de la Salut (ICS), Tarragona, Spain
e Universitary Hospital Joan XXIII, Institut Català de la Salut (ICS), Microbiology Department, Tarragona, Spain
f Primary Care Department Camp de Tarragona, Institut Catala de la Salut (ICS), Centre d’Atenció Primària (CAP) Dr. Sarró-Valls Urbà, Tarragona, Spain
g Primary Care Department Camp de Tarragona, Institut Català de la Salut (ICS), Centre d’Atenció Primària (CAP), Sant Pere i Sant Pau-Tarragona 5, Tarragona, Spain
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with a total of just over 250&#44;000 diagnosed cases&#59; the contagion curve grew again in June until reaching the maximum peak of second wave in mid-October and as of later January 2021&#44; in the middle of the third wave&#44; the Spanish Ministry of Health reports 2&#44;705&#44;001 cases and almost 58&#44;000 deaths&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is much information updating COVID-19 surveillance epidemiological data &#40;number of cases and deaths by demographic characteristics&#44; accumulated incidences&#44; ratios for positive laboratory testing&#44; etc&#41; but there is few population-based data on specific incidence and susceptibility for SARS-COV-2 infection in different population subgroups with distinct underlying&#8212;believed as at-risk&#8212;conditions&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Earlier studies regarding clinical characteristics and prevalence of comorbidities among COVID-19 patients reported that cardiovascular disease &#40;including hypertension&#41;&#44; chronic respiratory disease&#44; renal disease&#44; cancer&#44; diabetes mellitus&#44; obesity and smoking were major risk factors for severe COVID-19&#46; However&#44; most of these results &#40;mainly based on hospitalised severe cases&#41; are likely confounded by age and other unadjusted variables &#40;including other sociodemographic&#44; medical or health care-related factors&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Of note&#44; COVID-19 patients managed as outpatients were generally poorly represented in COVID-19 research studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;7</span></a> In this sense&#44; a UK report based on a primary care cohort found that positive SARS-CoV-2 testing was associated with similar risk factors &#40;except smoking&#41; as described for severe COVID-19 in hospital settings&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Nevertheless&#44; there is uncertainty about the possibility that some of these conditions although they increase the risk of severe COVID-19&#44; may not &#8220;per se&#8221; increase the risk of SARS-COV-2 infection&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this context&#44; we designed a large population-based cohort study aimed to investigate the incidence&#44; clinical characteristics&#44; susceptibility and risk profile of suffering COVID-19 among middle-aged and older adults &#40;who supported the greatest burden of COVID-19 at this time&#41; in the region of Tarragona across pandemic period&#46; First-time analyses reporting earlier data have been published&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> The present report updates population-based incidence data and risk of suffering laboratory-confirmed COVID-19 among cohort members by distinct underlying medical conditions &#40;previous comorbidities&#44; vaccinations&#8217; history and common chronic medications&#8217; use&#41;&#44; reporting final data observed at the end of the planned study period &#40;from 1st March to 30th June 2020&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design&#44; setting and study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">The design&#44; setting and study population have been extensively described elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> Briefly&#44; this is a population-based cohort study &#40;began in April 2020&#41; that included 79&#44;083 persons &#8805;50 years-old in Tarragona area&#44; whose total population &#40;all-age&#41; is 210&#44;672 inhabitants&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> The cohort incorporates all persons &#8805;50 years old assigned to 12 Primary Care Centres &#40;PCCs&#41; managed by the Institut Catal&#224; de la Salut &#40;ICS&#41; in the study area &#40;<span class="elsevierStyleItalic">Tarragon&#233;s&#44; Alt Camp and Conca de Barber&#224;</span> counties&#41;&#46; The reference Hospital and Laboratory for the 12 participating PCCs were <span class="elsevierStyleItalic">Hospital Universitari Joan XXIII</span> and its Microbiological Department in the city of Tarragona&#46; According to census data&#44; the study cohort represents approximately 75&#37; of inhabitants aged 50 years or older in the study area&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Cohort members were followed since March 1st 2020 &#40;date before the onset of the epidemic in the region&#41;&#44; until the appearance of any study event &#40;COVID-19 diagnosis or death&#41;&#44; or until the end of 4-month follow-up &#40;June 30&#44; 2020&#41;&#46; The study was approved by the Ethics Committee of the Foundation University Institute for Primary Health Care Research &#40;IDIAP Jordi Gol&#44; Barcelona&#44; file 20&#47;065-PCV&#41; and was conducted according to the Helsinki Declaration and Spanish legislation on biomedical studies&#44; data protection and respect for human rights&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Considering public health surveillance emergency&#44; informed consent for all cohort members was waived&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data sources</span><p id="par0040" class="elsevierStylePara elsevierViewall">An institutional clinical research database earlier used for other cohort studies in the area &#40;CAPAMIS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> was updated and became the primary data source for this COVID-19 epidemiologic report&#59; it includes administrative and clinical data &#40;coded according to the International Classification of Diseases 10th Revision&#44; ICD-10&#41;&#44; extracted from the PCCs&#8217; clinical records electronic system&#44; that operates since the 2000s&#46; We collected sociodemographic characteristics&#44; previous comorbidities&#44; chronic medications and vaccinations&#8217; history for cohort members in order to establish their baseline conditions &#40;at March 1&#44; 2020&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">When the COVID-19 epidemic period onset in the area&#44; two electronic alerts&#44; linked to COVID-19 laboratory tests results and ICD-10 codes for disease suspicion &#40;B34&#46;2 and B97&#46;29&#41;&#44; were added to the electronic clinical records system of PCCs&#46; Subsequently&#44; both data sources were associated in the anonymised research database used for this report&#46; Vital status for all cohort members was considered according to administrative data periodically updated in the electronic PCCs&#8217; clinical records &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows Study scheme&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Outcomes</span><p id="par0050" class="elsevierStylePara elsevierViewall">The main outcome was laboratory-confirmed COVID-19 diagnosed by Reverse Transcription-Polymerase Chain Reaction &#40;RT-PCR&#41; or serological testing&#46; For laboratory diagnosis of COVID-19&#44; guidelines of the Health Department of the Generalitat de Catalunya were implemented&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Of note&#44; the availability of PCR testing was scarce during the first weeks of epidemic period&#44; and they were prioritised for severe cases &#40;requiring hospital admission&#41; and nursing-home residences &#40;where several outbreaks took place&#41;&#44; while less PCR tests were made among possible cases with mild symptoms managed as outpatient&#46; For descriptive results we report suspected&#47;presumptive COVID-19 cases &#40;persons coded as clinical suspicion alone without PCR tested&#41; and&#44; additionally&#44; COVID-19-excluded cases &#40;PCR performed with a negative result&#41; among cohort members across study period&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Covariates</span><p id="par0055" class="elsevierStylePara elsevierViewall">Besides socio-demographic &#40;age&#44; sex and type of residence as community-dwelling&#47;nursing-home&#41;&#44; main covariates for this study were vaccinations&#8217; history &#40;influenza vaccine in prior autumn&#44; pneumococcal &#91;pneumococcal polysaccharide vaccine -PPV23- and pneumococcal conjugated vaccine -PCV13-&#93; or tetanus vaccination at any time&#41; and presence of pre-existing comorbidities&#46; The following comorbidities&#47;underlying conditions were considered according to ICD-10 codes data registered in the electronic PCCs clinical records on 01&#47;03&#47;2020&#58; neurological disease &#40;including dementia and stroke&#41;&#44; cancer &#40;solid organ or haematological neoplasia diagnosed in past 5 years&#41;&#44; chronic renal failure&#44; systemic autoimmune rheumatic diseases &#40;including rheumatoid arthritis and lupus&#41;&#44; chronic respiratory disease &#40;including chronic bronchitis&#47;emphysema and&#47;or asthma&#41;&#44; chronic heart disease &#40;including congestive heart failure&#44; coronary artery disease and other cardiopathies&#41;&#44; atrial fibrillation&#44; chronic liver disease &#40;including chronic hepatitis and cirrhosis&#41;&#44; arterial hypertension&#44; diabetes mellitus&#44; hypercholesterolemia&#44; obesity&#44; alcoholism and smoking&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In addition&#44; baseline use of some common chronic medications&#44; which could be hypothetically related with physiopathological mechanism of SARS-COV-2 infection or virulence &#40;e&#46;g&#46;&#44; antihypertensive&#44; antiplatelet&#47;anticoagulant and&#47;or anti-inflammatory drugs&#41;&#44; were also considered as exposure covariables possibly related with the occurrence of COVID-19 for the present study&#46; Thus&#44; active medication treatments in each cohort member on 01&#47;03&#47;2020&#44; coded according to the Anatomical&#44; Therapeutic&#44; and Chemical classification system &#40;ATC&#41; of the World Health Organization&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> were identified from the patient treatment plan registered in the PCC&#39;s clinical records system&#44; and included the following therapeutic groups&#58; antihypertensive &#40;diuretics&#44; beta-blockers&#44; angiotensin-converting enzyme inhibitors &#91;ACEIs&#93;&#44; angiotensin II receptor blockers &#91;ARBs&#93;&#44; calcium channel blockers&#41;&#44; statins&#44; anticoagulants &#40;warfarin and new oral anticoagulant drugs&#41;&#44; antiplatelet drugs&#44; antidiabetic drugs &#40;insulin&#44; oral antidiabetic drugs&#41;&#44; inhaled respiratory drugs&#44; antineoplastic agents&#44; systemic corticosteroids&#44; non-steroidal anti-inflammatory drugs &#40;NSAIDs&#41;&#44; chloroquine&#47;hydroxychloroquine&#44; antihistamines&#44; proton-pump inhibitors and benzodiazepines&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Criteria used to define and collect pre-existing conditions and chronic medications use are extensively described in an appendix elsewhere&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> A comorbidity&#47;medication was considered absent if it was not recorded&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analyses</span><p id="par0065" class="elsevierStylePara elsevierViewall">Descriptive statistics included frequencies&#44; percentages&#44; means and standard deviations &#40;SD&#41;&#46; Incidence rates &#40;IRs&#41; for laboratory-confirmed COVID-19 cases were calculated as person-weeks&#44; considering in the denominator the sum of the persons-time contributed for each cohort member during the study period &#40;17&#46;4 weeks&#41;&#46; Confidence intervals &#40;CIs&#41; for IRs were calculated assuming a Poisson distribution for uncommon events&#46; In bivariate analyses&#44; baseline characteristics according to final presence&#47;absence of study outcome &#40;COVID-19 diagnosis&#41; were compared using Chi-squared or Fisher&#39;s test as appropriate&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Cox regression analyses were used to calculate unadjusted&#44; age &#38; sex-adjusted and multivariable-adjusted hazard ratios &#40;HRs&#41; aimed at estimating the association between baseline exposure conditions and the time to the first outcome &#40;laboratory-confirmed COVID-19&#41; in cohort members throughout the study period &#40;from 1st March to 30th June 2020&#41;&#46; We included in exploratory multivariable Cox models all above mentioned exposure covariables &#40;i&#46;e&#46;&#44; age&#44; sex&#44; residence&#44; vaccinations&#8217; history&#44; comorbidities&#47;underlying conditions and medications use&#41;&#46; The method to select a subset of variables to include in final models was the purposeful selection&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> These models incorporate significant and confounder variables as well as all covariates judged clinically or epidemiologically relevant&#46; We performed a main analysis with the total study cohort &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#44;083&#41; and two subgroup analyses restricted to community-dwelling people &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#44;669&#41; and nursing-home residents &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1414&#41;&#46; Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 &#40;two-tailed&#41;&#46; Analyses were performed using IBM SPSS Statistics for Windows&#44; version 24 &#40;IBM Corp&#46;&#44; Armonk&#44; N&#46;Y&#46;&#44; USA&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">Study cohort included 37&#44;626 &#40;47&#46;6&#37;&#41; men and 41&#44;457 &#40;52&#46;4&#37;&#41; women&#44; with a mean age of 65&#46;8 &#40;SD&#58; 11&#46;3&#41; years&#46; Stratifying by age&#44; 42&#44;684 &#40;54&#37;&#41; were 50&#8211;64 years and 10&#44;386 &#40;13&#46;1&#37;&#41; were 80 years or more&#59; by residence&#44; 1414 &#40;1&#46;8&#37;&#41; were nursing-home residents and 77&#44;669 &#40;98&#46;2&#37;&#41; community-dwelling individuals&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Total cohort members were followed for 1&#44;356&#44;358 persons-weeks &#40;1&#44;335&#44;069 persons-weeks community-dwelling and 21&#44;289 persons-weeks nursing-home residents&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Of the 79&#44;083 cohort members&#44; 4084 &#40;5&#46;2&#37;&#41; were PCR tested for SARS-COV-2 infection across the study period&#46; Of them&#44; 3577 &#40;87&#46;6&#37;&#41; had a negative result and 507 &#40;12&#46;4&#37;&#41; a positive result &#40;319 in community-dwelling and 188 in nursing-home residents&#41;&#46; Additionally&#44; 29 cohort members had a positive laboratory serological testing for SARS-COV-2 &#40;twenty-six community-dwelling and three nursing-home residents&#41;&#46; Two hundred and eighty-three cohort members had a suspected &#40;clinically compatible&#41; COVID-19 without laboratory testing&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Of the 536 laboratory-confirmed COVID-19 cases&#44; 235 &#40;43&#46;8&#37;&#41; were men and 301 &#40;56&#46;2&#37;&#41; women&#44; with a mean age of 74 years &#40;SD&#58; 14&#46;4&#41;&#46; By age groups&#44; 177 &#40;33&#46;0&#37;&#41; occurred in those who were 50&#8211;64 years&#44; 137 &#40;25&#46;6&#37;&#41; in those 65&#8211;79 years and 222 &#40;41&#46;4&#37;&#41; in aged 80 years or more&#46; Three hundred and forty-five cases &#40;64&#46;4&#37;&#41; occurred in community-dwelling and 191 &#40;35&#46;6&#37;&#41; in nursing-home residents&#46; The most prevalent comorbidities were hypertension &#40;54&#46;1&#37;&#41;&#44; cardiac disease &#40;28&#46;5&#37;&#41;&#44; obesity &#40;25&#46;2&#37;&#41;&#44; diabetes &#40;23&#46;5&#37;&#41;&#44; respiratory disease &#40;14&#46;9&#37;&#41; and neurological disease &#40;14&#46;7&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows weekly distribution of COVID-19-confirmed cases and cumulative incidences at 7-day and 14-day across the 18 weeks of the study period&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Mean IR across study period was 39&#46;5 &#40;95&#37; CI&#58; 36&#46;1&#8211;43&#46;2&#41; cases per 100&#44;000 persons-week &#40;24&#46;1 in 50&#8211;64 years vs 30&#46;6 in 65&#8211;79 years vs 127&#46;0 in 80 years or older&#59; 36&#46;4 in men vs 42&#46;3 in women&#59; 25&#46;8 in community-dwelling vs 897&#46;2 in nursing-home residents&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">By underlying conditions&#44; maximum IRs &#40;per 100&#44;000 persons-week&#41; emerged among those persons with neurological diseases &#40;206&#46;0&#41; followed by atrial fibrillation &#40;109&#46;4&#41;&#44; chronic renal failure &#40;85&#46;9&#41;&#44; chronic heart disease &#40;66&#46;9&#41;&#44; inflammatory bowel disease &#40;66&#46;0&#41; and chronic respiratory disease &#40;64&#46;6&#41;&#46; According to baseline chronic medications&#44; maximum IRs appeared among those receiving diuretics &#40;97&#46;0&#41;&#44; oral anticoagulants &#40;87&#46;3&#41;&#44; insulin &#40;83&#46;1&#41;&#44; and inhaled-respiratory therapy &#40;72&#46;1&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows unadjusted&#44; age &#38; sex-adjusted and multivariable adjusted analyses evaluating risk of suffering laboratory-confirmed COVID-19 in the whole study cohort&#46; In the unadjusted analysis&#44; many previous comorbidities and medications were associated with increased risk&#46; However&#44; after multivariable-adjustment&#44; only age &#40;HR&#58; 1&#46;01&#59; 95&#37; CI&#58; 1&#46;00&#8211;1&#46;02&#41;&#44; nursing-home residence &#40;HR&#58; 20&#46;19&#59; 95&#37; CI&#58; 15&#46;98&#8211;25&#46;51&#41;&#44; neurological disease &#40;HR&#58; 1&#46;35&#59; 95&#37; CI&#58; 1&#46;03&#8211;1&#46;77&#41;&#44; taking diuretics &#40;HR&#58; 1&#46;39&#59; 95&#37; CI&#58; 1&#46;10&#8211;1&#46;75&#41;&#44; antiplatelet drugs &#40;HR&#58; 1&#46;36&#59; 95&#37; CI&#58; 1&#46;05&#8211;1&#46;76&#41;&#44; benzodiazepines &#40;HR&#58; 1&#46;24&#59; 95&#37; CI&#58; 1&#46;00&#8211;1&#46;53&#41; and history of PCV13 vaccination &#40;HR&#58; 1&#46;74&#59; 95&#37; CI&#58; 1&#46;06&#8211;2&#46;85&#41; appeared significantly associated with increased risk&#46; Smoking &#40;HR&#58; 0&#46;57&#59; 95&#37;CI&#58; 0&#46;41&#8211;0&#46;80&#41;&#44; taking ACEIs &#40;HR&#58; 0&#46;78&#59; 95&#37; CI&#58; 0&#46;61&#8211;1&#46;00&#41;&#44; ARBs &#40;HR&#58; 0&#46;70&#59; 95&#37;CI&#58; 0&#46;51&#8211;0&#46;96&#41; and statins &#40;HR&#58; 0&#46;75&#59; 95&#37; CI&#58; 0&#46;58&#8211;0&#46;96&#41; appeared associated with a reduced risk&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#sec0075">Supplementary Tables S1</a> &#40;incidence rate&#41; and S2 &#40;unadjusted and adjusted risks&#41; show subgroup analyses restricted to community-dwelling individuals &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#44;669&#41;&#46; In the multivariable analysis focused on these individuals&#44; chronic renal disease &#40;HR&#58; 1&#46;50&#59; 95&#37; CI&#58; 1&#46;02&#8211;2&#46;21&#41;&#44; cancer &#40;HR&#58; 1&#46;45&#59; 95&#37; CI&#58; 1&#46;05&#8211;2&#46;01&#41;&#44; cardiac disease &#40;HR&#58; 1&#46;32&#59; 95&#37; CI&#58; 0&#46;98&#8211;1&#46;79&#41;&#44; taking diuretics &#40;HR&#58; 1&#46;54&#59; 95&#37; CI&#58; 1&#46;11&#8211;2&#46;13&#41; and benzodiazepines &#40;HR&#58; 1&#46;28&#59; 95&#37; CI&#58; 0&#46;97&#8211;1&#46;68&#41; were related to increased risk&#46; Smoking &#40;HR&#58; 0&#46;51&#59; 95&#37; CI&#58; 0&#46;35&#8211;0&#46;74&#41;&#44; receiving ACEIs &#40;HR&#58; 0&#46;63&#59; 95&#37; CI&#58; 0&#46;45&#8211;0&#46;89&#41;&#44; statins &#40;HR&#58; 0&#46;66&#59; 95&#37; CI&#58; 0&#46;49&#8211;0&#46;90&#41; and influenza vaccination in prior autumn &#40;HR&#58; 0&#46;68&#59; 95&#37; CI&#58; 0&#46;51&#8211;0&#46;92&#41; were associated with decreased risk &#40;Table S2&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#sec0075">Supplementary Table S3</a> shows subgroup analyses restricted to nursing-home residents &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1414&#41;&#46; In the multivariable analysis&#44; increasing age &#40;HR&#58; 1&#46;03&#59; 95&#37; CI&#58; 1&#46;01&#8211;1&#46;05&#41;&#44; receiving oral anti-diabetic drugs &#40;HR&#58; 1&#46;79&#59; 95&#37; CI&#58; 1&#46;04&#8211;3&#46;08&#41;&#44; antineoplastic agents &#40;HR&#58; 2&#46;51&#59; 95&#37; CI&#58; 1&#46;05&#8211;6&#46;01&#41; and influenza vaccination in prior autumn &#40;HR&#58; 1&#46;56&#59; 95&#37; CI&#58; 1&#46;07&#8211;2&#46;29&#41; were associated with increasing risk&#46; In contrast&#44; taking ARBs &#40;HR&#58; 0&#46;47&#59; 95&#37; CI&#58; 0&#46;25&#8211;0&#46;87&#41; and history of tetanus vaccination &#40;HR&#58; 0&#46;63&#59; 95&#37; CI&#58; 0&#46;44&#8211;0&#46;91&#41; were associated with decreased risk&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Population-based clinical data on susceptibility and risk of SARS-COV-2 infection is limited&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;18</span></a> This large cohort study was aimed to assess population-based incidence of laboratory-confirmed COVID-19 among middle-aged and older adults with distinct underlying medical conditions in a well characterised geographic area &#40;Tarragona region&#41; during the first wave of the COVID-19 epidemic &#40;March&#8211;June 2020&#41;&#44; investigating possible relationships between pre-existing medical conditions with the susceptibility&#47;risk of suffering COVID-19&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">As main result&#44; we found a mean IR of 39&#46;5 laboratory-confirmed COVID-19 cases per 100&#44;000 persons-week throughout study period&#44; which is a relatively low incidence as compared to other Spanish or European regions during the same time period&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">During the study period &#40;17&#46;4 weeks since 1st March until 30th June 2020&#41;&#44; approximately 5&#37; of cohort members were PCR tested &#40;with 12&#46;4&#37; positive results&#41;&#46; Taking this data into account&#44; and considering that PCR test were scarcely available in the study area for patients with less severe symptoms during the first weeks of the epidemic period&#44; the true incidence of COVID-19 was logically underestimated&#46; Nevertheless&#44; considering the relatively low number of presumptive cases &#40;clinical suspicion alone without PCR performed&#41;&#44; our data also suggests that the overall number of infected people could be considerably lower than initially speculated &#40;as showed by the national seroprevalence study&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Assuming this relatively little incidence&#44; we found that increasing age&#44; nursing-home residence&#44; some pre-existing comorbidities &#40;cancer&#44; neurological&#44; renal or cardiac disease and taking certain chronic medications &#40;diuretics&#44; antiplatelet drugs and benzodiazepines&#41; were independent factors related to increased risk of suffering COVID-19&#46; In contrast&#44; cohort members receiving statins or ACEIs&#47;ARBs &#40;and&#44; in the case of community-dwelling individuals&#44; those vaccinated against influenza in prior autumn&#41; presented&#44; after multivariable-adjustment&#44; a decreased risk&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Of note&#44; in the crude analyses several covariates &#40;comorbidities&#44; medications and vaccinations&#41; appeared significantly associated with increased risk&#47;susceptibility of suffering COVID-19&#46; However&#44; for most of them the significance disappeared after age&#38;sex-adjustment and only a few remained independently associated with an increased risk after multivariable adjustments&#46; This highlights the importance of reporting adjusted data and note that differences in adjustment methods may explain&#44; in part&#44; the heterogeneous results reported to date evaluating the possible association between some pre-existing conditions and risk of COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">At present&#44; there is not clear evidence about possible clinical predisposing and protecting factors front SARS-COV-2 infection&#44; and uncertainty surrounds this issue&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">If we consider demographic characteristics&#44; apart from nursing-home residence that increased twenty-times the adjusted-risk of suffering laboratory-confirmed COVID-19&#44; we found that age increased approximately 1&#8211;2&#37; for each year the adjusted-risk of suffering COVID-19&#46; While COVID-19 was more frequent in women&#44; sex did not alter the risk of infection in multivariable analysis&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Considering pre-existing comorbidities&#44; only neurological disease &#40;basically patients with a history of dementia and&#47;or stroke living in nursing-home residences&#41; was associated with increased multivariable-adjusted risk of infection in the analysis of full cohort&#46; Concomitantly&#44; previous cancer&#44; renal disease and cardiac disease emerged associated with increased risk in subgroup analysis restricted to community-dwelling individuals&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In the present study&#44; chronic respiratory disease&#44; diabetes&#44; hypertension and obesity did not emerge independently associated with significant increased risk of suffering laboratory-confirmed COVID-19 after multivariable-adjusted analyses&#46; There is general accordance considering these conditions as major risk factors for poor prognosis in hospitalised COVID-19 patients&#44; but there is few data assessing their role in predisposing for SARS-COV-2 infection&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Surprisingly&#44; smokers presented the lowest specific incidence rate of COVID-19 in the present report&#44; and smoking was associated with a reduced risk of COVID-19&#44; both in multivariable analyses evaluating the total study cohort and in the restricted to community-dwelling individuals&#46; This unexpected result could be due to possible selection bias &#40;e&#46;g&#46;&#44; those who are current smokers may be healthier whereas those who suffered tobacco consequences may be currently non-smokers&#41;&#46; Notably&#44; active smoking has been linked with decreased odds of a positive result SARS-COV-2 test in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> Opposite findings about poor prognosis among smokers with COVID-19 have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Considering chronic medication use&#44; receiving diuretics&#44; antiplatelet drugs and benzodiazepines appeared associated with increased risk of suffering COVID-19&#46; In contrast&#44; taking statins and ACEIs or ARBs emerged associated with decreased risk&#46; At onset of COVID-19 pandemic&#44; after discovering that the host receptor for SARS-CoV-2 cell entry was the angiotensin-converting enzyme 2 &#40;ACE2&#41;&#44; it was feared that receiving ACEIs&#47;ARBs could facilitate SARS-COV-2 infection and predispose to suffer severe COVID-19&#46; However&#44; most recent studies have concluded that there is no clinical or experimental evidence supporting that ACEIs or ARBs augment the susceptibility to&#47;severity of COVID-19 at present&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Indeed&#44; ACEIs&#47;ARBs have been associated with lower incidence and&#47;or improved outcomes in patients with lower respiratory tract infections&#44; and with lower risk of all-cause mortality in COVID-19 hospitalised patients&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Considering statins&#44; while first studies reported opposite results&#44; our data showing a decreased risk of laboratory-confirmed COVID-19 among people taking statins is in accordance with conclusions of a recent meta-analysis on this concern&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Anyway&#44; caution is recommended until further evidence emerges surrounding statin use in COVID-19 patients&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Regarding other chronic medications that appeared associated with increased risk in the current study &#40;i&#46;e&#46;&#44; diuretics&#44; antiplatelet drugs and benzodiazepines&#41;&#44; we have not a clear interpretation for this data&#46; It is possibly due to an unresolved residual confounding&#44; linked to unmeasured health-care-related factors or insufficient age-adjustment&#44; but we also note that some of them &#40;e&#46;g&#46;&#44; benzodiazepines&#41; have already been reported associated with greater risk of pneumonia &#40;common clinical manifestation in COVID-19 patients&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Antihistamines&#8217; use was not associated with any statistically significant change in the risk of suffering COVID-19 in the present study&#46; We note that antihistamines&#8217; use was associated &#40;marginally significative&#41; with a lower risk of COVID-19 in an earlier report&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> but we also remark that it could be due to an alpha error considering that this final report has greater statistical power &#40;since include more persons-time follow-up and greater number of events analysed&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Similar to data observed in earlier analyses&#44; we found that influenza vaccination in prior autumn was associated with a reduction risk of suffering COVID-19 among community-dwelling individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Conversely&#44; it was associated with a greater risk in the subgroup of nursing-home residents &#40;where a protective association appeared for those who had received tetanus vaccination&#41;&#46; While these associations could be due to residual confounding related with unmeasured life-style or healthcare factors&#44; further investigations are needed exploring a possible immunity-related mechanism explanation&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Major strengths in this study were the large size and representativity of the study cohort&#44; that included almost 80&#44;000 people and represented about 75&#37; of the entire population over 50 years in the area&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> and the use of survival analysis methods to precisely asses susceptibility and risk of suffering a SARS-COV-2 infection adjusting by important potential confounders &#40;as socio-demographic&#44; and medical underlying conditions clinically relevant&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Major limitations were related to its partially retrospective design and poor access to PCR tests at the beginning of the epidemic period in our setting&#44; especially considering that the most specific diagnosis for COVID-19 is a positive PCR test&#46; Moreover&#44; its reliability depends on the correct collection of nasopharyngeal swabs&#44; moment of collection&#44; sensitivity of tests and guidelines for testing followed throughout the study period&#46; Due to above mentioned scarce availability of PCR tests they were mainly performed in hospitalised&#47;severe patients and in nursing homes &#40;after some outbreaks were detected&#41;&#46; Thereby&#44; patients with mild symptoms &#40;many of them without PCR done&#41; have been logically underestimated in this study&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Despite the large size of the cohort&#44; there were relatively few events &#40;536 laboratory-confirmed COVID-19 cases&#41;&#44; which limits statistical power&#46; This is especially relevant in the subgroup of nursing-home residents where&#44; even if great incidence occurred&#44; only 191 confirmed COVID-19 cases were collected and this fact largely affects the precision of estimates &#40;confidence intervals very wide&#41;&#46; Notwithstanding all mentioned limitations&#44; authors emphasise the added value that provide adjustments &#40;age&#38;sex and multivariable&#41;&#44; not present in many other studies&#46; Their importance is clearly evident if we compare&#44; for example in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; crude with adjusted results&#46; Nevertheless&#44; caution is needed before multivariable HRs interpretation&#46; Obviously&#44; the multivariable models may be incorrect and incomplete&#46; Multivariable analyses have inherent limitations and a residual confounding in estimated coefficients &#40;due to unobserved&#44; unmeasured or unknown factors&#41; may not be excluded&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">We must consider that the study was conducted in a single geographic area&#59; thus&#44; specific incidence data cannot be directly extrapolated to other regions with distinct epidemic conditions&#46; Nevertheless&#44; we also note that the adjusted-risks estimated here may be helpful to better characterise the risk profile &#40;socio-demographic&#44; pre-existing conditions&#47;comorbidities&#44; chronic medication use&#41; for suffering COVID-19 among middle-aged and older adults living in a setting with low&#47;moderate intensity of COVID-19&#44; as in the present study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">In summary&#44; in this large population-based study that followed a cohort of 79&#44;083 individuals &#8805;50 years old between March and June 2020 in Tarragona area&#44; the incidence of laboratory-confirmed SARS-COV-2 infection was relatively low &#40;39&#46;5 cases per 100&#44;000 persons-week&#41; as compared with that of other Spanish regions during the first wave of COVID-19 pandemic&#46; In this epidemic context &#40;low incidence&#41;&#44; our data supports that increasing age&#44; nursing-home residence&#44; pre-existing cancer&#44; neurological&#44; renal and cardiac disease are independent major predisposing conditions to suffer COVID-19 among middle-aged and older adults&#46; Patients receiving diuretics&#44; antiplatelet drugs and benzodiazepines were also at increased risk&#46; Oppositely&#44; patients taking statins&#44; renin&#8211;angiotensin&#8211;aldosterone system inhibitors and those community-dwelling individuals that received influenza vaccination in prior autumn presented decreased risk&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Contributors</span><p id="par0220" class="elsevierStylePara elsevierViewall">ESG and AVC wrote the manuscript&#59; CDC&#44; CTF&#44; FGB&#44; and IHG obtained data&#59; ESG and AVR assessed outcomes and did statistical analyses&#59; AVR edited the manuscript&#59; OOG and FML revised the final version&#59; AVC coordinated the study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0225" class="elsevierStylePara elsevierViewall">This study is supported by a grant from the <span class="elsevierStyleGrantSponsor" id="gs1">Instituto de Salud Carlos III of the Spanish Health Ministry</span> &#40;file COV20&#47;00852&#59; call for the SARS-COV-2&#47;COVID-19 disease&#44; RDL 8&#47;2020&#44; March 17&#44; 2020&#41;&#46; The funders had no role in study design&#44; data collection and analysis&#44; decision to publish&#44; or preparation of the manuscript</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">All authors&#44; none declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse susceptibility&#47;risk of suffering COVID-19 among adults with distinct underlying medical conditions&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Population-based cohort study involving 79&#44;083 individuals &#8805;50 years old in Tarragona &#40;Southern Catalonia&#44; Spain&#41;&#46; Baseline cohort characteristics &#40;demographic&#44; pre-existing comorbidities&#44; chronic medications and vaccinations history&#41; were established at study start &#40;01&#47;03&#47;2020&#41; and primary outcome was laboratory-confirmed COVID-19 occurred among cohort members throughout 01&#47;03&#47;2020&#8211;30&#47;06&#47;2020&#46; Risk of suffering COVID-19 was evaluated by Cox regression&#44; estimating multivariable hazard ratios &#40;HRs&#41; adjusted for age&#47;sex and pre-existing comorbidities&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Across study period&#44; 536 laboratory-confirmed COVID-19 cases were observed &#40;mean incidence&#58; 39&#46;5 cases per 100&#44;000 persons-week&#41;&#46; In multivariable-analysis&#44; increasing age&#47;years &#40;HR&#58; 1&#46;01&#59; 95&#37; CI&#58; 1&#46;00&#8211;1&#46;02&#41;&#44; nursing-home &#40;HR&#58; 20&#46;19&#59; 95&#37; CI&#58; 15&#46;98&#8211;25&#46;51&#41;&#44; neurological disease &#40;HR&#58; 1&#46;35&#59; 95&#37; CI&#58; 1&#46;03&#8211;1&#46;77&#41;&#44; taking diuretics &#40;HR&#58; 1&#46;39&#59; 95&#37; CI&#58; 1&#46;10&#8211;1&#46;75&#41;&#44; antiplatelet &#40;HR&#58; 1&#46;36&#59; 95&#37; CI&#58; 1&#46;05&#8211;1&#46;76&#41; and benzodiazepines &#40;HR&#58; 1&#46;24&#59; 95&#37; CI&#58; 1&#46;00&#8211;1&#46;53&#41; increased risk&#59; conversely&#44; taking angiotensin-converting-enzyme inhibitors &#40;HR&#58; 0&#46;78&#59; 95&#37; CI&#58; 0&#46;61&#8211;1&#46;00&#41;&#44; angiotensin-receptor-blockers &#40;HR&#58; 0&#46;70&#59; 95&#37;CI&#58; 0&#46;51&#8211;0&#46;96&#41; and statins &#40;HR&#58; 0&#46;75&#59; 95&#37; CI&#58; 0&#46;58&#8211;0&#46;96&#41; were associated with reduced risk&#46; Among community-dwelling individuals&#44; pre-existing cancer&#44; renal and cardiac disease appeared also related with an increased risk&#44; whereas influenza vaccination was associated with reduced risk&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In a setting with relatively low incidence of COVID-19 across the first wave of pandemic period&#44; increasing age&#44; nursing-home residence and multiple comorbidities appear predisposing for COVID-19 among middle-aged&#47;older adults&#46; Conversely&#44; statins&#44; angiotensin-receptor blockers&#47;inhibitors and influenza vaccination were related with decreased risk&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar incidencia y riesgo&#47;susceptibilidad de sufrir la COVID-19 en adultos seg&#250;n distintas condiciones m&#233;dicas preexistentes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cohorte de base poblacional que incluy&#243; 79&#46;083 personas &#8805;50 a&#241;os en Tarragona&#46; Caracter&#237;sticas basales de la cohorte &#40;edad&#47;sexo&#44; comorbilidades&#44; medicaciones cr&#243;nicas&#41; se establecieron a 01-03-2020 y se registraron todos los casos de COVID-19 confirmada ocurridos en miembros de la cohorte hasta el 30-06-2020&#46; Para estimaci&#243;n de riesgos se realiz&#243; regresi&#243;n de Cox&#44; con c&#225;lculo de hazard ratio &#40;HR&#41; ajustados por edad&#44; sexo y comorbilidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se observaron 536 casos confirmados de COVID-19 &#40;incidencia media&#58; 39&#44;5 casos por 100&#46;000 personas-semana&#41;&#46; En an&#225;lisis multivariante&#44; edad&#47;a&#241;os &#40;HR&#58; 1&#44;01&#59; IC el 95&#37;&#58; 1&#44;00-1&#44;02&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;050&#41;&#44; estar institucionalizado&#47;residencia &#40;HR&#58; 20&#44;19&#59; IC 95&#37;&#58; 15&#44;98-25&#44;51&#59; p&#60;0&#44;001&#41;&#44; enfermedad neurol&#243;gica &#40;HR&#58; 1&#44;35&#59; IC el 95&#37;&#58; 1&#44;03-1&#44;77&#41;&#44; diur&#233;ticos &#40;HR&#58; 1&#44;39&#59; IC 95&#37;&#58; 1&#44;10-1&#44;75&#41;&#44; antiagregantes plaquetarios &#40;HR&#58; 1&#44;36&#59; IC 95&#37;&#58; 1&#44;05-1&#44;76&#41; y benzodiacepinas &#40;HR&#58; 1&#44;24&#59; IC 95&#37;&#58; 1&#44;00-1&#44;53&#41; se asociaron con un riesgo aumentado de la COVID-19 analizando la totalidad de la cohorte&#59; contrariamente&#44; medicaci&#243;n IECA &#40;HR&#58; 0&#44;78&#59; IC el 95&#37;&#58; 0&#44;61-1&#44;00&#41;&#44; ARA-II &#40;HR&#58; 0&#44;70&#59; IC el 95&#37;&#58; 0&#44;51-0&#44;96&#41; y estatinas &#40;HR&#58; 0&#44;75&#59; IC el 95&#37;&#58; 0&#44;58-0&#44;96&#41; se asociaron con menor riesgo&#46; Entre personas no institucionalizadas&#44; c&#225;ncer&#44; nefropat&#237;a y cardiopat&#237;a se asociaron con mayor riesgo y vacunaci&#243;n antigripal con menor riesgo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En un &#225;rea con relativamente baja incidencia de COVID-19&#44; edad&#44; institucionalizaci&#243;n y m&#250;ltiples comorbilidades aumentaron el riesgo&#47;susceptibilidad de sufrir la COVID-19&#46; Contrariamente&#44; estatinas&#44; inhibidores del sistema renina-angiotensina y vacunaci&#243;n antigripal se asociaron con menor riesgo&#46;</p></span>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Weekly distribution of COVID-19-confirmed cases across study period &#40;March 1st&#8211;June 30th 2020&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">NOTE&#58; <span class="elsevierStyleItalic">p</span>-Values in univariate analysis were calculated by chi-squared&#44; or Fisher&#39;s test as appropriate&#44; comparing percentages in the study population vs COVID-19 cases&#59; IR denotes incidence rates per 100&#44;000 persons-week&#59; CIs denotes confidence intervals for incidence rates and were calculated assuming a Poisson distribution for uncommon events&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Characteristic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Study population&#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#44;083&#41;<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laboratory-confirmed COVID-19 cases &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>536&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Univariate analysis<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41; <span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time follow-up &#40;persons-week&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence rate&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Socio-demographic</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>50&#8211;64 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">177 &#40;33&#46;0&#41; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">734&#44;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">24&#46;1 &#40;20&#46;8&#8211;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>65&#8211;79 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">137 &#40;25&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">447&#44;474&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#46;6 &#40;25&#46;8&#8211;36&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;80 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10&#44;386 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">222 &#40;41&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">174&#44;761&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#46;0 &#40;110&#46;2&#8211;146&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">235 &#40;43&#46;8&#41; 0&#46;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">645&#44;470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">36&#46;4 &#40;32&#46;1&#8211;41&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#44;457 &#40;52&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">301 &#40;56&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">710&#44;888&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">42&#46;3 &#40;37&#46;7&#8211;47&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">77&#44;669 &#40;98&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">345 &#40;64&#46;4&#41; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#44;335&#44;069&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">25&#46;8 &#40;23&#46;2&#8211;28&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nursing-home residence</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1414 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191 &#40;35&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">897&#46;2 &#40;778&#46;8&#8211;1032&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neurological disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2317 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;14&#46;7&#41; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">206&#46;0 &#40;164&#46;4&#8211;257&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Renal disease</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4476 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;12&#46;1&#41; &#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;629&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;9 &#40;67&#46;4&#8211;109&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cancer</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6630 &#40;8&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1796 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;2&#46;1&#41; 0&#46;733&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">35&#46;7 &#40;17&#46;8&#8211;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">1614 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Systemic corticosteroids</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1252 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;1&#46;9&#41; 0&#46;599&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Incidence of laboratory-confirmed COVID-19 cases according to baseline demographical and clinical characteristics in the total study cohort &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#44;083&#41;&#46; Tarragona region &#40;Southern Catalonia&#44; Spain&#41;&#44; from 01&#47;03&#47;2020 to 30&#47;06&#47;2020&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NOTE&#58; HRs denotes Hazard ratios&#44; and were calculated for those who had the condition as compared with those who had not the condition&#46; In multivariable-adjusted analysis the HRs were adjusted for age &#40;continuous years&#41;&#44; sex&#44; residence&#44; comorbidities&#47;underlying conditions and chronic medications use&#46; CIs denote confidence intervals&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sex&#58; women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16 &#40;0&#46;98&#8211;1&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;00 &#40;0&#46;84&#8211;1&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89 &#40;0&#46;74&#8211;1&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nursing-home residence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;18 &#40;27&#46;80&#8211;39&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;80 &#40;19&#46;18&#8211;29&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;19 &#40;15&#46;98&#8211;25&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neurological disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;86 &#40;4&#46;62&#8211;7&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;01 &#40;2&#46;33&#8211;3&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;35 &#40;1&#46;03&#8211;1&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;33 &#40;1&#46;80&#8211;3&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;09 &#40;0&#46;83&#8211;1&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01 &#40;0&#46;76&#8211;1&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;57 &#40;1&#46;22&#8211;2&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16 &#40;0&#46;90&#8211;1&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;18 &#40;0&#46;91&#8211;1&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rheumatic disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;19 &#40;0&#46;57&#8211;2&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;07 &#40;0&#46;51&#8211;2&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;29 &#40;0&#46;59&#8211;2&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;74 &#40;1&#46;38&#8211;2&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;36 &#40;1&#46;07&#8211;1&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16 &#40;0&#46;83&#8211;1&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;97 &#40;1&#46;63&#8211;2&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;21 &#40;1&#46;00&#8211;1&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99 &#40;0&#46;79&#8211;1&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;02 &#40;2&#46;35&#8211;3&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;57 &#40;1&#46;20&#8211;2&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;25 &#40;0&#46;83&#8211;1&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Liver disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;12 &#40;0&#46;61&#8211;2&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;26 &#40;0&#46;69&#8211;2&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;13 &#40;0&#46;62&#8211;2&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;52 &#40;1&#46;25&#8211;1&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;13 &#40;0&#46;92&#8211;1&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;09 &#40;0&#46;76&#8211;1&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;49 &#40;1&#46;26&#8211;1&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;83 &#40;0&#46;69&#8211;1&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97 &#40;0&#46;77&#8211;1&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89 &#40;0&#46;73&#8211;1&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81 &#40;0&#46;66&#8211;0&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;90 &#40;0&#46;73&#8211;1&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;43 &#40;0&#46;31&#8211;0&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69 &#40;0&#46;49&#8211;0&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;57 &#40;0&#46;41&#8211;0&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alcoholism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;90 &#40;0&#46;50&#8211;1&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16 &#40;0&#46;64&#8211;2&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96 &#40;0&#46;52&#8211;1&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Chronic medications use</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diuretics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;95 &#40;2&#46;43&#8211;3&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;71 &#40;1&#46;39&#8211;2&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;39 &#40;1&#46;10&#8211;1&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Beta blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;41 &#40;1&#46;12&#8211;1&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01 &#40;0&#46;80&#8211;1&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;94 &#40;0&#46;73&#8211;1&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACEIs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;03 &#40;0&#46;84&#8211;1&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;75 &#40;0&#46;61&#8211;0&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;78 &#40;0&#46;61&#8211;1&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ARBs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89 &#40;0&#46;67&#8211;1&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62 &#40;0&#46;47&#8211;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;70 &#40;0&#46;51&#8211;0&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Calcium channel blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;52 &#40;1&#46;17&#8211;1&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;04&#40;0&#46;80&#8211;1&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;19 &#40;0&#46;90&#8211;1&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Statins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;80 &#40;0&#46;64&#8211;1&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;60 &#40;0&#46;48&#8211;0&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;75 &#40;0&#46;58&#8211;0&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral anticoagulants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;35 &#40;1&#46;79&#8211;3&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;29 &#40;0&#46;98&#8211;1&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;18 &#40;0&#46;76&#8211;1&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antiplatelet drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;94 &#40;1&#46;57&#8211;2&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;21 &#40;0&#46;97&#8211;1&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;36 &#40;1&#46;05&#8211;1&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;20 &#40;1&#46;61&#8211;3&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;64 &#40;1&#46;20&#8211;2&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;24 &#40;0&#46;85&#8211;1&#46;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral antidiabetic drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;22 &#40;0&#46;97&#8211;1&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94 &#40;0&#46;74&#8211;1&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;02 &#40;0&#46;70&#8211;1&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inhaled respiratory drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;96 &#40;1&#46;54&#8211;2&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;43 &#40;1&#46;12&#8211;1&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;23 &#40;0&#46;87&#8211;1&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antineoplastic agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;10 &#40;0&#46;62&#8211;1&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;04 &#40;0&#46;59&#8211;1&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;94 &#40;0&#46;51&#8211;1&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Systemic corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;20 &#40;0&#46;64&#8211;2&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88 &#40;0&#46;47&#8211;1&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;80 &#40;0&#46;42&#8211;1&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NSADs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;71 &#40;0&#46;46&#8211;1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;84 &#40;0&#46;54&#8211;1&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;13 &#40;0&#46;72&#8211;1&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antihistamines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;67 &#40;0&#46;40&#8211;1&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;68 &#40;0&#46;41&#8211;1&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73 &#40;0&#46;43&#8211;1&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PPV23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCV13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tetanus&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 00257753
Original language: English
DOI:10.1016/j.medcli.2021.03.027
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