{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:54:37Z","timestamp":1753890877906,"version":"3.41.2"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Epidemiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sickle cell trait\/disease (SCT\/SCD) are enriched among Black people and associated with various comorbidities. The overrepresentation of these characteristics prevents traditional regression approach obtaining convincing evidence for the independent effect of SCT\/SCD on other health outcomes. This study aims to investigate the association between SCT\/SCD and COVID-19-related outcomes using causal inference approaches that balance the covariate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We leveraged electronic health record (EHR) data from the University of Chicago Medicine between March 2020 and December 2021. Demographic characteristics were retrieved. Medical conditions were identified using ICD-10 codes. Five approaches, including two traditional regression approaches (unadjusted and adjusted) and three causal inference approaches [covariate balancing propensity score (CBPS) matching, CBPS weighting, and CBPS adjustment], were employed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 112,334 patients were included in the study, among which 504 had SCT and 388 SCD. Patients with SCT\/SCD were more likely to be non-Hispanic Black people, younger, female, non-smokers, and had a diagnosis of diabetes, heart failure, asthma, and cerebral infarction. Causal inference approaches achieved a balanced distribution of these covariates while traditional approaches failed. Across these approaches, SCD was consistently associated with COVID-19-related pneumonia (odds ratios (OR) estimates, 3.23 (95% CI: 2.13\u20134.89) to 2.57 (95% CI: 1.10\u20136.00)) and pain (OR estimates, 6.51 (95% CI: 4.68\u20139.06) to 2.47 (95% CI: 1.35\u20134.49)). While CBPS matching suggested an association between SCD and COVID-19-related acute respiratory distress syndrome (OR\u2009=\u20092.01, 95% CI: 0.97\u20134.17), this association was significant in other approaches (OR estimates, 2.96 (95% CI: 1.69\u20135.18) to 2.50 (95% CI: 1.43\u20134.37)). No association was observed between SCT and COVID-19-related outcomes in causal inference approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using causal inference approaches, we provide comprehensive evidence for the link between SCT\/SCD and COVID-19-related outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fepid.2023.1241645","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T04:31:46Z","timestamp":1694579506000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the impact of sickle cell disease on COVID-19 susceptibility and severity: a retrospective cohort study based on electronic health 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