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Different COVID-19 outcomes among systemic rheumatic diseases: a nation-wide cohort study
Vasiliki-Kalliopi Bournia1, George E Fragoulis1, Panagiota Mitrou2
1Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School.
Insights
Patients with systemic rheumatic diseases like RA, SLE, and SSc faced higher COVID-19 hospitalization and death risks. These findings highlight the need for prioritized vaccination and treatments for these vulnerable populations.
Area of Science:
- Rheumatology and Infectious Diseases
- Epidemiology of Systemic Rheumatic Diseases
- COVID-19 Impact on Immune-Mediated Conditions
Background:
- Systemic rheumatic diseases (RA, AS, PsA, SLE, SSc) involve immune dysregulation.
- The impact of COVID-19 on these patient groups requires thorough investigation.
- Understanding pandemic-related mortality risks is crucial for public health strategies.
Purpose of the Study:
- To assess COVID-19 hospitalization and mortality risks in RA, AS, PsA, SLE, and SSc patients.
- To compare these risks against the general population during the first year of the pandemic.
- To analyze changes in all-cause mortality for these conditions compared to pre-pandemic levels (2019).
Main Methods:
- Utilized nationwide electronic registries to track COVID-19 outcomes and all-cause deaths.
- Included 74,970 adult patients with RA, AS, PsA, SLE, and SSc.
- Matched patients 1:5 with general population comparators based on age, sex, and region; analyzed 2019 mortality data.
Main Results:
- Elevated COVID-19 hospitalization rates observed in RA, SLE, and SSc compared to the general population.
- Higher COVID-19 associated death rates were noted in RA patients.
- Among infected individuals, RA and SSc patients showed increased odds of COVID-19 associated death; RA all-cause mortality increased, while SSc decreased compared to 2019.
Conclusions:
- COVID-19 poses a more severe threat to individuals with systemic rheumatic diseases.
- Specific rheumatic conditions are linked to increased COVID-19 mortality.
- Urgent need for prioritized vaccination and tailored treatments for patients with systemic rheumatic diseases.
Objectives:
To investigate coronavirus disease 2019 (COVID-19)-associated risk of hospitalization and death in RA, AS, PsA, SLE and SSc in comparison with the general population during the first year of the pandemic, and compare their overall mortality with 2019.
Methods:
Interlinking nationwide electronic registries, we recorded confirmed COVID-19-associated infections, hospitalizations and deaths, and all-cause deaths between 1 March 2020 and 28 February 2021 in all adults with RA, AS, PsA, SLE and SSc under treatment (n = 74 970, median age 67.5, 51.2, 58.1, 56.2 and 62.2 years, respectively) and in random comparators from the general population matched (1:5) on age, sex and region of domicile. Deaths from all causes during 2019 were also recorded.
Results:
Compared with the general population, incidence rates (IR) for COVID-19-associated hospitalization were higher in RA [IR ratio (IRR) 1.71(1.50-1.95)], SLE [2.0 (1.4-2.7)] and SSc [2.28 (1.29-3.90)], while COVID-19-associated death rates were higher in RA [1.91 (1.46-2.49)]. When focusing only on severe acute respiratory syndrome coronavirus 2-infected subjects, after adjusting for age and gender, the odds ratio for COVID-19 associated death was higher in RA [1.47 (1.11-1.94)] and SSc [2.92 (1.07-7.99)] compared with the general population. The all-cause mortality rate compared with the general population increased in RA during the first year of the pandemic (IRR 0.71) with reference to 2019 (0.59), and decreased in SSc (IRR 1.94 vs 4.36).
Conclusion:
COVID-19 may have a more severe impact in patients with systemic rheumatic disease than in the general population. COVID-19-related mortality is increased in subgroups of patients with specific rheumatic diseases, underscoring the need for priority vaccination and access to targeted treatments.
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