The Association of Latitude and Altitude with COVID-19 Symptoms: A VIRUS: COVID-19 Registry Analysis

Aysun Tekin, Shahraz Qamar, Vikas Bansal, Salim Surani, Romil Singh, Mayank Sharma, Allison M. Lemahieu, Andrew C. Hanson, Phillip J. Schulte, Marija Bogojevic, Neha Deo, Devang K. Sanghavi, Rodrigo Cartin-Ceba, Nitesh K. Jain, Amy B. Christie, Uluhan Sili, Harry L. Anderson, Joshua L. Denson, Ashish K. Khanna, Igor Borisovich ZabolotskikhAbigail T. La Nou, Murtaza Akhter, Surapaneni Krishna Mohan, Kenneth W. Dodd, Lynn Retford, Karen Boman, Vishakha K. Kumar, Allan J. Walkey, Ognjen Gajic, Juan Pablo Domecq, Rahul Kashyap

Research output: Contribution to journalArticlepeer-review


Background: Better delineation of COVID-19 presentations in different climatological conditions might assist with prompt diagnosis and isolation of patients. Objectives: To study the association of latitude and altitude with COVID-19 symptomatology. Methods: This observational cohort study included 12267 adult COVID-19 patients hospitalized between 03/2020 and 01/2021 at 181 hospitals in 24 countries within the SCCM Discovery VIRUS: COVID-19 Registry. The outcome was symptoms at admission, categorized as respiratory, gastrointestinal, neurological, mucocutaneous, cardiovascular, and constitutional. Other symptoms were grouped as atypical. Multivariable regression modeling was performed, adjusting for baseline characteristics. Models were fitted using generalized estimating equations to account for the clustering. Results: The median age was 62 years, with 57% males. The median age and percentage of patients with comorbidities increased with higher latitude. Conversely, patients with comorbidities decreased with elevated altitudes. The most common symptoms were respiratory (80%), followed by constitutional (75%). Presentation with respiratory symptoms was not associated with the location. After adjustment, at lower latitudes (<30º), patients presented less commonly with gastrointestinal symptoms (p<.001, odds ratios for 15º, 25º, and 30º: 0.32, 0.81, and 0.98, respectively). Atypical symptoms were present in 21% of the patients and showed an association with altitude (p=.026, odds ratios for 75, 125, 400, and 600 meters above sea level: 0.44, 0.60, 0.84, and 0.77, respectively). Conclusions: We observed geographic variability in symptoms of COVID-19 patients. Respiratory symptoms were most common but were not associated with the location. Gastrointestinal symptoms were less frequent in lower latitudes. Atypical symptoms were associated with higher altitude.

Original languageEnglish (US)
Article numbere187430642207130
JournalOpen Respiratory Medicine Journal
Issue number1
StatePublished - 2022

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine


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