BMJ Medicine . HR 165 at peak. Request for providers that treat COVID-19, although some of the providers in the system may treat COVID. Chung is concerned about the link between the disease and POTS, but hes glad that patients are getting a diagnosis, so they can pursue treatment. volume1,pages 11321133 (2022)Cite this article. Therefore, deriving precise estimates of risk per exposure is difficult, and follow-up studies are needed to determine the absolute risk of POTS after vaccination. 2022 Aug;122(4):1081-1083. doi: 10.1007/s13760-022-02002-2. Cardiovasc. No help with heart rate and GI. Immunol Res. He and his colleagues note that standard POTS treatment starting with conservative therapies like salt tablets, hydration, structured exercise programs, and compressive stockings have been used to manage these patients. The symptoms of POTS include but are not limited to lightheadedness (occasionally with fainting), difficulty thinking and concentrating (brain fog), fatigue, intolerance of exercise, headache, blurry vision, palpitations, tremor and nausea. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In the USA, the pre-pandemic prevalence of POTS has been estimated to be in the range of 500,0003,000,000 people, affecting predominantly women of reproductive age and roughly 1 in 100 teenagers3. Annu Rev Med. Of the vaccinees, 62%, 31%, 7.0%, and <0.10% received BNT162b2 (Pfizer-BioNTech), messenger ribonucleic acid (mRNA)-1273 (Moderna), Ad26.COV2.S (Johnson & Johnson), and other COVID-19 vaccines (ChAdOx1-S, CoronaVac, and NVX-CoV2373), respectively. Retrieved on March 04, 2023 from https://www.news-medical.net/news/20221214/What-is-the-relation-between-COVID-19-vaccination-and-new-POTS-related-diagnoses.aspx. An official website of the United States government. I will not get a third booster dose. We are able to more definitively say that we think that this is a real observation, he said. News-Medical. This suggests that those with symptomatic COVID-19 infection were more likely to develop POTS in general, and that the risk of post-infection POTS is much higher than post-vaccination POTS in this cohort12. New-onset POTS can also follow vaccination (Fig. In this article, News-Medical talks to Sartorius about biosensing and bioprocessing in gene therapy, Officials decided to keep the current rules in place until that date to give health care facilities and local public health agencies time to prepare for the change and adjust safety policies. POTS was more likely to be diagnosed than a collection of common primary care diagnoses (OR 1.10; 95% CI 1.03-1.17), although there was a stronger association between vaccination and myocarditis (OR 2.57; 95% CI 1.02-6.77). CAS This is despite several case series reported from different countries and two studies that demonstrated an increased signal for POTS and its associated symptom clusters following HPV vaccination, based on data from the World Health Organizations pharmacovigilance database and a meta-analysis of clinical study reports from 24 clinical trials9,10,11. We recognized that pharmaco-epidemiology studies had previously used self-controlled designs, wherein patients serve as their own control3. Furthermore, the authors showed that the odds of new POTS-associated diagnoses following natural SARS-CoV-2 infection were more than five times higher compared to the post-vaccination period12. Concerning POTS-related diagnoses, post-COVID-19 risks were 5.4-fold greater compared to the risks post-SARS-CoV-2 vaccinations. 04 March 2023. My daughter and I both have autoimmune conditions: I have lupus. J. Neurol. Copyright 2023. However, my internet research shows this is also a drug that should be used short term because of the same side effects, permanent muscle twitching, etc.. By continuing to browse this site you agree to our use of cookies. "In our contemporary practice, we are seeing patients who have previously been infected with COVID-19 present with symptoms consistent with POTS," said Jonathan Hsu, MD, cardiologist at UC San Diego Health. This content is available for meeting attendees and/or Platinum Members. End of August, went to ER with continuing upper GI problems. From these results, we can conclude that POTS might be occurring at a higher-than-expected frequency following COVID-19 vaccination, although at an overall rate lower than the frequency of POTS occurring following SARS-CoV-2 infection. Current POTS reported: 66 VAERS Events, 69 to ER, 33 Hospitalized, 4 deaths. February 2022?heart rate still increases. Sorry, I misunderstood your concern. Moderna announced a free COVID vaccine program. The 90 day mark post vaccine was a nightmare. Google Scholar. After vaccination, the odds of a POTS-related diagnosis were 10% higher than the odds of a diagnosis not related to POTS. For the vaccine part of the study, the investigators examined electronic medical records from 284,592 vaccinated individuals (mean age 52 years; 57% women). Still, their age was marginally higher (average age of 60 years, 47% were women, and 59% were Whites). Since early reports of post-acute infection sequelae of SARS-CoV-2 (PASC) emerged in the media,. 40, 8190 (2017). J. Intern. As of mid July, they cant see me till late August 2023. SARS-CoV-2 vaccinations elicit immune responses to the SARS-CoV-2 S (spike) glycoprotein. 69, 205211 (2021). GI problems continue. Now, POTS is being diagnosed among long COVID patients. The main analysis was repeated with the second vaccine dose as the index study exposure and using cluster bootstrapping. Researchers suspect that vasomotor denervation causes dilation of the blood vessels, leading to reduced preload to the heart, which triggers an increase in the central sympathetic nervous system response. Rev. One of the remaining approvals was for severe allergic shock and one was for a type of skin swelling called angioedema. However, they found that people diagnosed with COVID-19 are five times more likely to develop POTS after being infected than after getting vaccinated. I have now lost 18 pounds since January. 2021 Apr;69(2):205-211. doi: 10.1007/s12026-021-09185-5. This type of analysis is inherently difficult owing to the lack of ideal controls, multiple confounding factors related to the context of the pandemic and the effect of COVID-19 vaccination on patients engagement with the healthcare system. FOIA On my third ER visit for another severe POTS episode, the ER doctor did give me a prescription for Metoclopramide(GI drug..among other things). And in a broader context, its important to raise awareness about POTS itself within cardiology because there are treatments, there are ways to help these patients feel better, Kwan said. The mRNA-based COVID-19 vaccines are effective at preventing infection . The COVID-19 pandemic has profoundly affected worldwide health through both acute illness and the long-term effects of infection. Even without clear mechanisms to explain the findings, the medical community should be aware of the potential links between COVID-19 and vaccination and POTS, Kwan said. BMC Med. Moderna said people without insurance will be able to get its COVID vaccine at no cost after the U.S. government . All Rights Reserved. This paper describes and analyses different methods for pharmacoepidemiological studies. I have only had 1 brief flare up. Continued studies is the the only way to get down to the truth and find treatments that work. (2022, December 14). Went to an electrophysiologist who confirmed I have POTS and said it is directly related to my GI problems which were definitely a result of the Covid 19 virus. doi: 10.1007/s10072-021-05662-9. Rare Side Effects of COVID Vaccines Myocarditis and the COVID-19 Vaccines. Probably had it for years but no dx. a, Post-vaccination odds by diagnosis in all patients. 2023 Cedars-Sinai. government site. Sue. Authors Jeonghyun Park 1 , Sanghyun Kim 1 , Jusuck Lee 1 , Jae Young An 2 Affiliations 1 Department of Neurology, College . I have now been in bed for about 8 months except for going to the Dr. 5 days latter I try to get to my car to drive to a dr appt and I pass out in the garage for 9 minutes. On the contrary, two POTS-related conditions, fatigue and EDS (Ehler-Danlos syndrome), showed lower odds. J. Additionally, POTS odds (1.3, n=4,526) were higher than. Toshniwal Paharia, Pooja Toshniwal Paharia. Only 4 of them (13%) had an autoimmune background before COVID-19 vaccination. Connect with thousands of patients and caregivers for support and answers. POTS, a common disorder of the autonomic nervous system, is characterized by an increase in heart rate of at least 30 beats per minute within 10 minutes of standing and symptoms of orthostatic intolerance, such as pre-syncope, palpitations, light-headedness, generalized weakness, headache and nausea, with symptom duration exceeding three months2. Find more COVID-19 testing locations on Maryland.gov. Once diagnosed, many patients face . In bed for 5 weeks. The ER admitted me for severe dehydration and 24 hr observation. There is no way to tease that information out of the VAERS data. Article Slider with three articles shown per slide. 32, 307311 (2022). When looking for a potential link between SARS-CoV-2 infection and POTS, Kwan et al examined electronic health records from 12,460 individuals (mean age 47 years; 50% women) with a documented infection. Enter the email you used to register to reset your password. What is the relation between COVID-19 vaccination and new POTS-related diagnoses?. Toshniwal Paharia, Pooja Toshniwal Paharia. Internet Explorer). 2022;Epub ahead of print. Sanada Y, Azuma J, Hirano Y, Hasegawa Y, Yamamoto T. Cureus. Of course, it's been awhile since your post, so perhaps this information is too late. 71, 235248 (2020). In general, the vaccines developed to combat COVID-19 safely and effectively reduce the risk of severe outcomes, although some rare side effectsmost notably, myocarditishave been reported following widespread rollout of the shots. 2021;69:205211. Moreover, the traditional POTS diagnostic criteria require symptoms to occur over a duration of at least 3 months that is, at least 90 days which is the assessed period. In a sequence-symmetry analysis, which used individuals as their own controls and compared risks in the 90 days before exposure with those in a similar interval after exposure, the likelihood of receiving one of these diagnoses was higher after vaccination (OR 1.33; 95% CI 1.25-1.41). Second, the general awareness and diagnostic vigilance of POTS and access to adequate diagnostic modalities are decisive for POTS incidence reliability. Cardiovascular specialist Alan C. Kwan, MD, is an investigator with the Smidt Heart Institute at Cedars-Sinai. J. Intern. Vaccination efforts against COVID-19 have been instrumental in limiting transmission and preventing severe disease. We are vaccinating all eligible patients. Two sequencesymmetry analyses were performed with different retrospective cohorts of individuals who received COVID-19 vaccinations and those with COVID-19 history. https://doi.org/10.1038/s44161-022-00194-7, DOI: https://doi.org/10.1038/s44161-022-00194-7. The likelihood of getting diagnosed with postural orthostatic tachycardia syndrome (POTS) increases after both COVID-19 and vaccination against SARS-CoV-2 infection, although COVID-19 itself poses a greater risk, observational data suggest. Muscle Nerve. A condition called POTS rose after covid, but patients can't find care A life-changing condition called POTS, which can cause fainting, irregular heartbeats and dizziness, particularly among young women, appears to be on the rise as a result of the coronavirus pandemic. For months noone new what was wrong and would roll thier eyes wheb I mention Pfizer. Dev. Whatever side of the covid/vaccine side you are on people actually died . I had virtually no reaction to the first shot, and had fever and aches with the third, but no secondary autoimmune flare. If your child caught COVID-19 and went on to develop symptoms of long COVID, then you'll be all too familiar with the knock-out exhaustion that defines this globally trending, post-viral malaise. The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: its worth a shot. I hope this helps you with your decision-making. -. J. Cardiovasc. In the meantime, to ensure continued support, we are displaying the site without styles Accessibility Immunol Res. Unauthorized use of these marks is strictly prohibited. Johns Hopkins' medical concierge services offer complimentary assistance with appointments and travel planning. In this interview, we speak to Ceri Wiggins, a Director at AstraZeneca, about the many applications of CRISPR and its role in discovering new COPD therapies. There are numerous triggers for POTS including viruses, vaccines, and an autoimmune basis. POTS is a clinical syndrome that manifests with orthostatic intolerance and postural tachycardia 1. I now am ok diltiazem and that lowers my pulse and my breathing has normalized.. Studies have reported POTS as a potential post-acute coronavirus disease 2019 sequela (PASC). They said I have a UTI and discharged me with an antibiotic. Most (62%) received the shot from Pfizer/BioNTech, 31% the one from Moderna, 7% the Janssen vaccine from Johnson & Johnson, and less than 0.1% a mix of other shots. One week after my first Moderna vaccine I developed POTS symptoms. Kwon, A. et al. Res. This is a summary of: Kwan, A. C. et al. The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: its worth a shot, https://doi.org/10.1038/s44161-022-00180-z. Who can help?? on this website is designed to support, not to replace the relationship Although POTS was previously recognized as a condition that can develop after SARS-CoV-2 infection2, data on its potential development after vaccination have been scarce. Provided by the Springer Nature SharedIt content-sharing initiative, Nature Cardiovascular Research (Nat Cardiovasc Res) I suggest that any of us with these issues consider sticking with Pfizer. Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-CoV-2 COVID infection. https://www.news-medical.net/news/20221214/What-is-the-relation-between-COVID-19-vaccination-and-new-POTS-related-diagnoses.aspx. PubMedGoogle Scholar. We found that most POTS-related diagnoses increased after COVID-19 vaccination to a greater degree than non-POTS-related diagnoses (Fig. Since April 2021, some people have developed myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) after receiving the Pfizer-BioNTech or Moderna coronavirus vaccines in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). Never got vaccinated. My GI issues continue. POTs symptoms continued and got worse. 2022. The vaccine put me directly into a POTs, but perhaps I had POTs previously and it exacerbated my symptoms or I had COVID and did not know it and I developed POTs as others with COVID have experienced. Among the post-SARS-CoV-2 vaccination cohort of 284,592 individuals, the average age was 52.0years, 57.0% were women, and 63% were Whites. TODAYrecently interviewed Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute, about recent study findings showing that heart attack deaths among young people, ABCNews.com recently interviewed infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai, to discuss the recent increase in norovirus cases and how to avoid getting sick. POTS is clinically diagnosed on the basis of orthostatic dizziness, pre-syncope, palpitations, and a table tilt test or 10.0-minute standing test demonstrating elevated heart rate when changing from a supine position to a standing position. (accessed March 04, 2023). Kwan reports no relevant conflicts of interest. In this study, we observed occurences of POTS following COVID-19 vaccination, albeit at a lower rate than following COVID-19 infection. You are using a browser version with limited support for CSS. Latter that evening I try again to get out of bed and my heart went crazy! 18, 115 (2018). 1997;20:15611568. Gastroenterologist thought it was my gallbladder. My heart rate had always been normal. Receive the the latest news, research, and presentations from major meetings right to your inbox. Clipboard, Search History, and several other advanced features are temporarily unavailable. I am worried about NON POTS reactions in POTS patients. I appreciate reading this. A lot of people with chronic fatigue and heart palpitations end up in physiatry clinics because they are debilitated. Photo by Cedars-Sinai. A 2022 review notes that an estimated 2% to 14% of people who've had COVID-19 may experience POTS in the months after their illness. Since the COVID-19 pandemic, there has been an increase in POTS diagnosis among patients. Shaw, B. H. et al. I tell you this not to deter you from getting the vaccine, but to advise you to work closely with your doctors before deciding. Hi Ali - I looked and I looked - and I failed. Thank you! The rates of POTS after infection were so much higher that this shouldnt be taken as anything discouraging vaccination, he added. Called 911. & S.C. The study by Kwan et al. He prescribed 20 pills 4 x daily for 5 days. I am not sure where to direct you next, although your cardiologist might have access to current information in their medical journals. 66, 744754 (2018). But will that be accessible enough? As POTS is a frequently under-recognized condition that can cause substantial debility in affected patients4, greater understanding of POTS in general is required to improve overall awareness and rates of appropriate diagnosis and treatment. Nat Cardiovasc Res. Takeuchi, Y., Shinozaki, T. & Matsuyama, Y. Correspondence to "What is the relation between COVID-19 vaccination and new POTS-related diagnoses?". She is the highest ranking Australian medical doctor to admit to being COVID-19 vaccine injured (read more here):"This is an issue that I have witnessed first-hand with my wife who suffered a severe neurological reaction to her first Pfizer vaccine within . My daughter had dizziness with first and second, in a delayed reaction that was probably inflammatory, but was okay with the third. The authors declare no competing interests. (I also still get the lower dose of flu shot due to fear of inflammatory reaction to the larger dose for us older folks.) Cardiovasc. History of POTS: 610 VAERS Events, 148 to ER, 29 Hospitalized. 2022 Nov 2;14(11):e31006. Have now been on Pantoprazole, rabiprazole(sp). CRF is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. Med. Key Takeaways. In collaboration with the Johns Hopkins Post-Acute COVID-19 Team (PACT) service, the Johns Hopkins Division of Infectious Disease and other domestic and international partners, Chung is coordinating research to understand the incidence of POTS after COVID-19 and whether the incidence is the same as after other infections. https://doi.org/10.1038/s44161-022-00177-8 (2022). Early July I started experiencing dizziness, wooziness when I got up to let the dog out. Kwan and colleagues observed, from a large health organization clinical database, a potential increase in the incidence of POTS following COVID-19 vaccination. 2022, Kwan, A. C. We hope that our results can offer an evidence-based context of understanding for patients who experience POTS-like symptoms after COVID-19 vaccination, as well as their healthcare providers. Join our newsletter! 79, 23252330 (2022). He put me on 50 mg 2 times per day of Metoprolol and .1mg of fludrocortisone. This paper reports prospective evaluation of patients using formal testing to diagnose POTS as part of long-COVID syndrome. Connect with thousands of patients and caregivers for support, practical information, and answers. So sweet of you, thanks Sue, I did the same thing and also found this. Click here to watch the complete segment on ABC 7. doi: 10.1007/s12026-021-09185-5. A study just published in December 2022 found that upon examining patients who developed long COVID-19, 39 percent of women met the criteria to be diagnosed with POTS, while only 7 percent of men . Fedorowski, A. et al. In this interview, AZoM speaks to Rohan Thakur, the President of Life Science Mass Spectrometry at Bruker, about what the opportunities of the market are and how Bruker is planning on rising to the challenge. The current proposed pathology for POTS is an inability to regulate blood volume. Can cause muscle twitching etc. Postural orthostatic tachycardia syndrome (POTS) can follow COVID-19 as part of the post-acute sequelae of SARS-CoV-2 infection, but it can also develop after COVID-19 vaccination. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients Immunol Res. I think vaccination is still your best option to protect your health, including from POTS related to [SARS-CoV-2] infection.. The face of postural tachycardia syndrome - insights from a large cross-sectional online community-based survey. Although POTS was previously recognized as a condition that can develop after SARS-CoV-2. End of July I have a torn labrum repaired. More info. 2023 Feb 14;329(6):454-456. doi: 10.1001/jama.2023.0050. while also discussing the various products Sartorius produces in order to aid in this. 2022;43:340. These scenarios include patients who begin having POTS symptoms during the acute phase of COVID-19, and patients who dont present with POTS symptoms until weeks after the acute phase. A case of transient POTS following COVID-19 vaccine. I will not be getting any further booster shots. Calked my Gastroenterologist for more and he does not like to use it long term. Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection, Inappropriate sinus tachycardia in post-COVID-19 syndrome, Reports of acute adverse events in mRNA COVID-19 vaccine recipients after the first and second doses in Japan, COVID-19 pandemic and hypertension: an updated report from the Japanese Society of Hypertension project team on COVID-19, Long COVID: major findings, mechanisms and recommendations, Cardiac involvement in the long-term implications of COVID-19, Understanding the role of nACE2 in neurogenic hypertension among COVID-19 patients, Heart rate variability comparison between young males after 46weeks from the end of SARS-CoV-2 infection and controls, Seroconversion dynamic and SARS-CoV-2 seropositivity in unvaccinated population during the first and second outbreaks in Mexico, https://doi.org/10.1038/s44161-022-00177-8. 1998-2023 Mayo Foundation for Medical Education and Research. Came back the next day and said I might have POTS. examined the frequency of new POTS-associated diagnoses POTS, dysautonomia, fatigue, mast cell disorders and EhlersDanlos syndrome before and after COVID-19-vaccination12. Given the complex design of our study, which was intended to account for potentially important confounders, the estimated risks are reported in relative terms; that is, after exposure relative to before exposure or POTS-related diagnoses relative to non-POTS-related diagnoses. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. POTS can cause a rapid increase in heartbeat, fainting, dizziness and fatigue. Ali I was teaching someone else to use the VAERS reports, and I found the information you were seeking. <3, I have had COVID twice. Jamal, S. M. et al. Vaccines represent one of the most groundbreaking scientific advances that substantially reduced the mortality and morbidity associated with various infectious pathogens. TCTMD All rights reserved. Epub 2021 Mar 30. Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection, Inappropriate sinus tachycardia in post-COVID-19 syndrome, Reports of acute adverse events in mRNA COVID-19 vaccine recipients after the first and second doses in Japan, COVID-19 pandemic and hypertension: an updated report from the Japanese Society of Hypertension project team on COVID-19, A nationwide questionnaire study of post-acute symptoms and health problems after SARS-CoV-2 infection in Denmark, Long COVID: major findings, mechanisms and recommendations, Long-term neurologic outcomes of COVID-19, Cardiac involvement in the long-term implications of COVID-19, Heart rate variability comparison between young males after 46weeks from the end of SARS-CoV-2 infection and controls, https://doi.org/10.1038/s44161-022-00177-8. b, Post-infection odds by diagnosis in all patients. Diagnosed with pots earlier, this is not some new found side effect, this was reported on back in mid, Popular artificial sweetener associated with elevated risk of heart attack and stroke, study shows, Study supports the concept of atherosclerosis as a T-cell autoimmune disease targeting the arterial wall, New method can potentially catch COVID-19 infections quickly with near-perfect accuracy, The Effect of Intermittent Fasting on the Gut Microbiome, The Impact of Cyberbullying on Mental Health, Association between cardiovascular disease and transportation noise revealed in new research, Novel predictors of severe respiratory syncytial virus infections among infants below the age of one, Analysis provides new insights into complex effects of Alzheimers disease on the retina, Naked mRNA delivered using needle-free PYRO injection presents a safe and effective potential vaccination method, Innovative method to spot bacteria in blood, wastewater, and more. -, Garg RK, Paliwal VK. By December 2020, the program had received a flood of referrals for patients exhibiting symptoms similar to those of POTS, after Chungs colleagues from comparable programs across the country were reporting that they, too, were receiving a large number of patient referrals dealing with POTS-like symptoms. Accumulating all POTS-associated diagnoses in one group gave slightly lower odds. Among SARS-CoV-2-infected individuals, the novel diagnoses odds and the corresponding occurrence rates showed increasing trends, especially for POTS, hypertension, and diabetes. So he has offered to write me a prescription for Domperidone available out of Canada. Si vous souhaitez personnaliser vos choix, cliquez sur Grer les paramtres de confidentialit. For COVID-19-vaccinated individuals, POTS odds were higher 90 days post-vaccination compared to those 90 days prior to vaccination. As we continue to navigate and mitigate the SARS-CoV-2 pandemic and long-term post-COVID-19 complications with the help of COVID-19 vaccines, the need to invest in POTS research to advance our understanding, diagnosis and management of POTS a common sequela of both SARS-CoV-2 infection and COVID-19 vaccination has never been more pressing. Our hospital played a substantial role in both care for patients and vaccination efforts in Los Angeles during the initial phases of the COVID-19 pandemic. Bisaccia, G. et al. exploring the link between the COVID-19 vaccine and a debilitating heart condition known as postural orthostatic tachycardia syndrome (POTS). He did suggest I speak with my cardiologist first(because of possible side effects). Tran, V-T., et al. Patients with postural orthostatic tachycardia syndrome, a disorder of the autonomic nervous system, can experience a rapid heart beat, fainting and dizziness. POTS-associated diagnoses included POTS along with dysautonomia, mast cell disorders, fatigue, and Ehlers-Danlos syndrome. As the coronavirus disease 2019 (COVID-19) pandemic continues, you might have questions about COVID-19 vaccines. However, current prevalence is likely significantly higher owing to post-COVID-19 POTS, which can develop as part of the post-acute sequelae of SARS-CoV-2 infection (PASC)4,5. 8, 156 (2021). Clustered bootstrapping yielded similar OR values.
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