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Among persons with COVID-19 and myocarditis, some myocarditis diagnoses might represent cases of multisystem inflammatory syndrome (MIS), particularly among children aged <16 years ( 9). However, it likely reflects the low risk for myocarditis among female patients without COVID-19 ( 5).Īlthough the exact mechanism of SARS-CoV-2 infection possibly leading to myocarditis is unknown, the pathophysiology is likely similar to that of other viruses ( 1). The finding of a higher risk ratio among females than among males is novel. The risk difference for myocarditis between persons with and without COVID-19 was higher among males than among females, consistent with some earlier studies ( 2, 5). This age-related differential misclassification (underascertainment) of COVID-19 status might bias risk differences and risk ratios toward the null more for younger adults and could partially explain the observed age-related association. This finding might be partially explained by age-related differences in COVID-19 case ascertainment, because younger adults with less severe disease might be less likely than older adults to have a health care encounter with a COVID-19 diagnosis captured within PHD-SR. In this study, the association between COVID-19 and myocarditis was lowest for persons aged 25–39 years and higher among younger (<16 years) and older (≥50 years) age groups, a pattern that has not been previously described in age-stratified analyses and that warrants further investigation.
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Before this report, the two largest known studies, in the United States and in Israel, also found that COVID-19 was strongly associated with myocarditis (U.S. These findings suggest an association between COVID-19 and myocarditis, although causality cannot be inferred from observational data, and are consistent with those from previous studies ( 2– 5). Further, in this cohort, approximately 40% of patients with myocarditis had a history of COVID-19. The risk for myocarditis among patients with COVID-19 during March 2020–January 2021 was nearly 16 times as high as the risk among patients without COVID-19, with the association between COVID-19 and myocarditis being most pronounced among children and older adults.
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In this study, the occurrence of myocarditis inpatient encounters was 42% higher in 2020 than in 2019. After adjusting for patient and hospital characteristics, patients with COVID-19 during March 2020–January 2021 had, on average, 15.7 times the risk for myocarditis compared with those without COVID-19 (95% confidence interval = 14.1-17.2) by age, risk ratios ranged from approximately 7.0 for patients aged 16-39 years to >30.0 for patients aged 30.0 for patients aged <16 years and ≥75 years. During March 2020–January 2021, the period that coincided with the COVID-19 pandemic, the risk for myocarditis was 0.146% among patients diagnosed with COVID-19 during an inpatient or hospital-based outpatient encounter and 0.009% among patients who were not diagnosed with COVID-19. Myocarditis inpatient encounters were 42.3% higher in 2020 than in 2019. hospital-based administrative database of health care encounters from >900 hospitals. CDC assessed this association using a large, U.S.
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Emerging data suggest an association between COVID-19 and myocarditis ( 2– 5). Viral infections are a common cause of myocarditis, an inflammation of the heart muscle (myocardium) that can result in hospitalization, heart failure, and sudden death ( 1).