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Increased COVID-19 mortality in patients with rheumatic diseases: results from the CONTROL-19 study by the Italian
Anna Zanetti1, Greta Carrara2, Gianpiero Landolfi2
1Epidemiology Research Unit, Italian Society for Rheumatology, Milan, and Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
Insights
Patients with rheumatic musculoskeletal diseases (RMD) and COVID-19 had a significantly higher mortality risk compared to the general population in Italy. These findings highlight the critical need for enhanced COVID-19 prevention strategies in RMD patients.
Area of Science:
- Rheumatology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic posed a significant threat globally, with varying mortality risks across different patient populations.
- Rheumatic musculoskeletal diseases (RMD) encompass a range of chronic inflammatory and autoimmune conditions that may influence disease outcomes.
Purpose of the Study:
- To compare COVID-19 mortality rates between patients diagnosed with RMD and the general Italian population.
- To identify specific RMD subgroups with elevated mortality risk during the initial phases of the pandemic.
Main Methods:
- Analysis of a national surveillance database (CONTROL-19) of RMD patients with COVID-19 in Italy (March-November 2020).
- Comparison with age-, sex-, and geographically-adjusted official Italian population data.
- Logistic regression models and sensitivity analyses were employed to assess mortality risk.
Main Results:
- The RMD patient cohort (n=668) exhibited a significantly higher mortality risk (OR 3.10) compared to the general population, even after adjusting for demographic factors.
- Excess mortality risk persisted after accounting for surveillance bias (OR 2.08) and was more pronounced in younger patients and women.
- Patients with systemic autoimmune diseases faced a greater risk of death than those with other RMDs.
Conclusions:
- COVID-19 infection was associated with substantially increased mortality among patients with RMD during the early pandemic in Italy.
- Urgent implementation of robust SARS-CoV-2 preventive measures is crucial for individuals with rheumatic diseases.
Objectives:
To investigate differences in coronavirus disease 2019 (COVID-19) mortality between patients with rheumatic musculoskeletal diseases (RMD) and the general population in Italy.
Methods:
We analysed the data from the national surveillance study promoted by the Italian Society for Rheumatology (CONTROL-19 database) including patients with RMD and COVID-19 between 26 March 2020 and 29 November 2020, compared with official data from the Italian population (within the same period) adjusted for age, sex and geographic location. The main outcome of the analyses was mortality. The relationship between RMD and mortality was analysed using adjusted logistic models and sensitivity analyses were conducted to support the robustness of our results.
Results:
We included 668 RMD patients (62.7% with inflammatory arthritis, 28.6% with systemic autoimmune diseases), who had a mean age of 58.4 years and of which 66% were female. Compared to the general population, the RMD population showed an increased risk of death (OR 3.10 (95% CI 2.29-4.12)), independently from the differences in age and sex distribution. Even after considering the potential influence of surveillance bias, the OR was 2.08 (95% CI: 1.55-2.73). Such excess of risk was more evident in the subgroup of younger patients, and more consistent in women. Subjects with systemic autoimmune diseases showed a higher risk of death than patients with any other RMDs.
Conclusions:
Patients with RMD and COVID-19 infection evidenced a significant increase in mortality during the first pandemic phases in Italy. These findings support the need for strong SARS-CoV-2 prevention in patients with rheumatic diseases.