COVID-19 Vaccination, Hospitalization Rates, and Mortality Differ Between People with Diagnosed Immune Mediated...

Vaccination reduces Coronavirus disease-19 (COVID-19) infection severity. We evaluated COVID-19 vaccine uptake and effectiveness in people with immune mediated inflammatory diseases (pIMIDs) versus the general population.

Using population-based administrative health records, we identified cohorts between 2004 and 2022 with an IMID (rheumatoid arthritis n = 10,405, systemic autoimmune rheumatic disease n = 5888, inflammatory bowel disease n = 7911, multiple sclerosis n = 3665, psoriasis n = 23,948) who were matched (1:5) by age, sex, and region to general population comparators (n = 243,490) without these IMIDs. Between 1 January 2021 and 31 March 2022, rates of COVID-19 vaccine administration, hospitalizations with COVID-19 (Hosp-C), and all-cause mortality were assessed amongst pIMIDs and comparators using multivariable models.

More pIMIDs were vaccinated than comparators (87.3% vs. 84.7%, p < 0.0001). IMID diagnosis, increasing age, female sex, higher socioeconomic status, urban residence, immunotherapy use, and comorbidities were associated with increased odds of receiving at least two vaccine doses. pIMIDs had higher rates of Hosp-C (79 per 100,000, 95% confidence interval (CI) 77.8-80.2) than comparators (51 per 100,000, 95% CI 50.5-51.3; rate ratio 1.55; 95% CI 1.53, 1.58) and greater mortality [pIMID 1758 deaths, 3.61%; comparators (6346 deaths, 2.61%), RR 1.39 95% CI 1.32, 1.46)]. In multivariable analyses, vaccinated status was associated with less Hosp-C (OR 0.27, CI 0.23, 0.32) and death (HR 0.27 CI 0.24, 0.29); the association did not differ between IMID and comparator groups.

Although COVID-19 vaccination reduced the risk of Hosp-C and death in both pIMIDs and comparators, pIMIDs remained at higher risk for both. Since SARS-CoV-2 is now endemic, these findings may inform ongoing vaccination recommendations.