College of Graduate Studies: Theses & Dissertations

Term of Award

Summer 2026

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (restricted to Georgia Southern)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Department

Jiann-Ping Hsu College of Public Health

Committee Chair

Logan Cowan

Committee Member 1

Chun Hai (Isaac) Fung

Committee Member 2

Kelly Sullivan

Committee Member 3

Jessica Schwind

Abstract

While mechanisms underlying cardiovascular outcomes following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and Coronavirus disease 2019 (COVID-19) vaccination require further clarification, additional clarity is needed to determine the strength of the association between SARS-CoV-2 infection, COVID-19 vaccination, and short-term cardiovascular outcomes to safeguard the most vulnerable populations. Using All of Us data, three manuscripts were developed to explore these associations.

The first and the second manuscripts used a matched on timing of event case-control study and conditional logistic regression adjusted for age, sex, race, comorbidities, and receiving cardiovascular medication to compare the occurrence of SARS-CoV-2 infection and COVID-19 vaccination (first, second, additional, and total dose) at a 90-day exposure interval and a 2-day washout period prior to MI diagnosis with a preceding control period. Compared to controls, MI cases had higher odds of SARS-CoV-2 infection [adjusted odds ratio (OR) 4.81, 95% confidence interval (CI) 2.90-7.98], indicating MI may be part of COVID-19’s clinical picture. Similarly, higher odds of COVID-19 vaccination among cases compared to corresponding controls were identified for the additional COVID-19 vaccination dose [adjusted OR 1.60, (95% CI 1.05-2.42)] but not for other doses.

Using an observed-to-expected analysis, the third manuscript calculated sex differences in the enhanced risk of myocarditis, if any, 28 and 60 days after receiving different doses of COVID-19 vaccines. Myocarditis SMR >1 for all vaccines’ first and second doses was found. For the additional dose, SMR varied (< or > 1) based on the type of vaccine. Variations in the SMR magnitude between males and females by vaccine type indicated the risk may be platform-related.

Research Data and Supplementary Material

No

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