Gout, Rheumatoid Arthritis, and the Risk of Death Related to Coronavirus Disease 2019: An Analysis of the UK Biobank

  1. Ruth K. Topless
  2. Amanda Phipps‐Green
  3. Megan Leask
  4. Nicola Dalbeth
  5. Lisa K. Stamp
  6. Philip C. Robinson
  7. Tony R. Merriman

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Abstract

The objectives for this study were to assess whether gout and/or rheumatoid arthritis (RA) are risk factors for coronavirus disease 2019 (COVID‐19) diagnosis and to assess whether gout and/or RA are risk factors for death from COVID‐19.

Methods

We used data from the UK Biobank. Multivariable‐adjusted logistic regression was employed in the following analyses: analysis A, to test for association between gout and/or RA and COVID‐19 diagnosis (n = 473,139); analysis B, to test for association between gout and/or RA and death from COVID‐19 in a case‐control cohort of people who died of or survived COVID‐19 (n = 2059); analysis C, to test for association between gout and/or RA and death from COVID‐19 in the entire UK Biobank cohort (n = 473,139).

Results

RA, but not gout, was associated with COVID‐19 diagnosis in analysis A. Neither RA nor gout was associated with risk of death in the group diagnosed with COVID‐19 in analysis B. However, RA was associated with risk of death related to COVID‐19 by using the UK Biobank cohort in analysis C, independent of comorbidities and other measured risk factors (odds ratio [OR] 1.9; 95% confidence interval CI 1.2–3.0). Gout was not associated with death related to COVID‐19 in the same UK Biobank analysis (OR 1.2; 95% CI 0.8–1.7).

Conclusion

RA is a risk factor for death from COVID‐19 by using the UK Biobank cohort. These findings require replication in larger data sets that also allow for inclusion of a wider range of factors.

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  1. Version published to 10.1002/acr2.11252
  2. Version published to 10.1101/2020.11.06.20227405v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.11.06.20227405: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are limitations to our analyses. Firstly, these analyses pertain to the population from which the UK Biobank was derived, predominantly the white European middle-aged ethnic group of the United Kingdom, and are not necessarily generalisable to other ethnic groups or other white European ethnic groups. There is also no available information on recovery status so there is the possibility of additional unidentified deaths in the COVID-19 diagnosed group in Analysis B. In addition to this COVID-19 outcomes will have been influenced over the time period of this study (March-August 2020) as clinical treatments evolved. General practice prescriptions were only available up until August 2019 and could not reliably be used to determine current medication usage. Thus the effect of anti-rheumatic treatments, particularly biologic disease-modifying antirheumatic drugs, could not be assessed in this study. Nor could the potential effect of disease activity in RA be assessed. Limited testing outside of the hospital settings means that the full extent of SARS-CoV-2 infection is not known in this population. Thus, it is not possible to accurately compare asymptomatic or mild COVID-19 to those with more severe disease. The UK Biobank dataset is also limited to those aged 49 to 86 as of 2020, a demographic with a higher infection fatality ratio (28). This will have contributed to the inflated infection fatality ratio in the UK Biobank cohort of 22%, well above general population estimate...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  4. Version published to 10.1101/2020.11.06.20227405v1 on medRxiv