{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:23:15Z","timestamp":1787008995603,"version":"build-2736575974"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Down syndrome (DS) is associated with an increased risk of infections attributed to immune defects. Whether individuals with DS are at an increased risk of severe coronavirus disease 2019 (COVID-19) remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a matched cohort study, we evaluated the risk of COVID-19 infection and severe COVID-19 disease in individuals with DS and their matched counterparts in a pre-COVID-19 vaccination period at Kaiser Permanente Southern California. Multivariable Cox proportion hazard regression was used to investigate associations between DS and risk of COVID-19 infection and severe COVID-19 disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our cohort included 2541 individuals with DS and 10\u2009164 without DS matched on age, sex, and race\/ethnicity (51.6% female, 53.3% Hispanic, median age 25 years [interquartile range, 14\u201338]). Although the rate of COVID-19 infection in individuals with DS was 32% lower than their matched counterparts (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], .56\u2013.83), the rate of severe COVID-19 disease was 6-fold higher (aHR, 6.14; 95% CI, 1.87\u201320.16).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although the risk of COVID-19 infection is lower, the risk of severe disease is higher in individuals with DS compared with their matched counterparts. Better infection monitoring, early treatment, and promotion of vaccine for COVID-19 are warranted for DS populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiac236","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T13:10:55Z","timestamp":1656076255000},"page":"757-765","source":"Crossref","is-referenced-by-count":3,"title":["Risk of Severe Coronavirus Disease 2019 Disease in Individuals With Down Syndrome: A Matched Cohort Study From a Large, Integrated Health Care System"],"prefix":"10.1093","volume":"226","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9469-5875","authenticated-orcid":false,"given":"Jennifer H","family":"Ku","sequence":"first","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myron J","family":"Levin","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, School of Medicine, University of Colorado , Aurora, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Florea","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I Chun","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung Fu","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,6,24]]},"reference":[{"key":"2022091319150878500_jiac236-B1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/B978-0-12-804766-8.00017-0","article-title":"Down syndrome","volume":"167","author":"Rafii","year":"2019","journal-title":"Handb Clin Neurol"},{"key":"2022091319150878500_jiac236-B2","first-page":"208","article-title":"Down syndrome \u2013 genetics and 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