血型與COVID-19醫療利用之相關性

ABO血型系統作為人體重要的遺傳標記，其在感染性疾病易感性中的作用日益受到關注。本研究旨在評估ABO血型對COVID-19感染風險及醫療利用的影響，探討血型作為風險分層工具的潛在價值。 本研究採用回顧性世代研究設計，利用TriNetX美國協作網絡資料庫（US Collaborative Network），納入2020年1月1日至2024年12月31日期間具有ABO血型資料且符合納入標準的成年患者（18－64歲）。排除惡性腫瘤、HIV感染、懷孕及基線前已感染COVID-19者。以O型血為對照組，分別與A、B、AB型血進行1:1傾向性評分匹配(Propensity score matching, PSM)，配對變項包括人口學特徵、社經地位、生活型態、共病症、用藥史及實驗室檢查結果。主要結果為COVID-19感染發生率，次要結果包括全因住院、急診就醫、加護病房入住及死亡率。採用Cox比例風險模型計算風險比（Hazard Ratios, HR）及95％信賴區間。 經傾向性評分匹配，配對後，共納入230,514名O型血與A型血配對者，88,233名O型血與B型血配對者，以及19,331名O型血與AB型血配對者。追蹤3年結果顯示：（1）COVID-19感染風險在O型血相較於A型血中未觀察到統計上顯著差異（HR：0.989, 95％ CI：0.967－1.011）；COVID-19感染風險在O型血相較於B型血中具有顯著差異（HR：1.056, 95％ CI：1.018－1.095, p＝0.003）；COVID-19感染風險在O型血相較於AB型血中未觀察到統計上顯著差異（HR：1.032, 95％ CI：0.958－1.113）；（2）醫療利用在O型血相較於AB型血有較高的住院風險（HR：1.046, 95％ CI：1.012－1.082），但具有較低的急診就醫風險（HR：0.868, 95％ CI：0.836－0.902）；（3）次群組分析在年輕族群(18-30歲)中，COVID-19感染風險在O型血相較於B型血中具有顯著差異（HR：1.081, 95％ CI：1.003－1.164）。 本研究提供大規模真實世界證據，顯示ABO血型與COVID-19易感性存在關聯。O型血相較於B型血具有較高的COVID-19感染風險，然而，血型對COVID-19在死亡率中未觀察到統計上顯著差異，而經由長期追蹤設計及嚴謹的配對分析，為理解宿主遺傳因素在新興傳染病中的作用並提供重要見解，本研究結果支持將ABO血型納入COVID-19風險評估模型，但仍需進一步研究闡明其分子機制，並評估血型在疫苗接種策略及個人化預防措施中的應用價值。

The ABO blood group system, as an important genetic marker in humans, has garnered increasing attention for its role in infectious disease susceptibility. This study aimed to evaluate the impact of ABO blood type on COVID-19 infection risk and healthcare utilization, exploring the potential value of blood type as a risk stratification tool. This retrospective cohort study utilized the TriNetX US Collaborative Network database, including adult patients (aged 18-64 years) with documented ABO blood type data who met inclusion criteria between January 1, 2020, and December 31, 2024. Patients with malignancies, HIV infection, pregnancy, or baseline COVID-19 infection were excluded. Using blood type O as the reference group, 1:1 propensity score matching (PSM) was performed separately with blood types A, B, and AB. Matching variables included demographic characteristics, socioeconomic status, lifestyle factors, comorbidities, medication history, and laboratory results. The primary outcome was COVID-19 infection incidence, while secondary outcomes included all-cause hospitalization, emergency department visits, intensive care unit admission, and mortality. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). After propensity score matching, the study included 230,514 matched pairs of type O and type A blood, 88,233 matched pairs of type O and type B blood, and 19,331 matched pairs of type O and type AB blood. Three-year follow-up results revealed: (1) No statistically significant difference in COVID-19 infection risk was observed between type O and type A blood (HR: 0.989, 95% CI: 0.967-1.011); type O blood showed significantly higher COVID-19 infection risk compared to type B blood (HR: 1.056, 95% CI: 1.018-1.095, p=0.003); no statistically significant difference was observed between type O and type AB blood (HR: 1.032, 95% CI: 0.958-1.113). (2) Regarding healthcare utilization, type O blood demonstrated higher hospitalization risk compared to type AB blood (HR: 1.046, 95% CI: 1.012-1.082), but lower emergency department visit risk (HR: 0.868, 95% CI: 0.836-0.902). (3) Subgroup analysis in younger populations (18-30 years) showed significantly higher COVID-19 infection risk in type O compared to type B blood (HR: 1.081, 95% CI: 1.003-1.164). This study provides large-scale real-world evidence demonstrating an association between ABO blood type and COVID-19 susceptibility. Type O blood exhibited higher COVID-19 infection risk compared to type B blood. However, no statistically significant differences in mortality were observed across blood types. Through long-term follow-up design and rigorous matching analysis, this study provides important insights into the role of host genetic factors in emerging infectious diseases. The findings support incorporating ABO blood type into COVID-19 risk assessment models, though further research is needed to elucidate the molecular mechanisms and evaluate the utility of blood type in vaccination strategies and personalized preventive measures.