Systematic review of the association between ABO blood type and COVID-19 incidence and mortality

A large proportion of COVID-19 research has been focused on identifying markers of high-risk individuals. However, this research often fails to consider basic epidemiologic concepts to prevent bias in the design, selection, and analysis of observational data. One suspected marker of risk that has been repeatedly assessed is ABO blood type. Given the ease of measuring this biomarker, it is an appealing target for identifying high-risk individuals. However, this same ease of measurement makes associational research on ABO blood type and COVID prone to a range of common epidemiologic errors. We conducted a systematic review of studies assessing correlations between ABO blood type and COVID incidence, hospitalization, and mortality to determine the quality of evidence these studies provide and whether the overall evidence suggests ABO blood type could provide a useful indicator of COVID risk. We conclude that most existing studies are low quality and suffer from major methodological flaws. The few higher-quality studies which do exist find no association between ABO blood type and COVID outcomes. We conclude that there is no evidence to support the use of ABO blood type as a marker for COVID risk or severity. Key PointsO_LIThere is no sufficient evidence to conclude a biological relationship between ABO blood types and COVID-19 infection or severity. C_LIO_LIBiases of existing research could be avoided by careful study design. C_LI