COVID-19 infection, admission and death among people with rare autoimmune rheumatic disease in England: results from the RECORDER project

  1. Megan Rutter
  2. Peter C Lanyon
  3. Matthew J Grainge
  4. Richard Hubbard
  5. Emily Peach
  6. Mary Bythell
  7. Peter Stilwell
  8. Jeanette Aston
  9. Sarah Stevens
  10. Fiona A Pearce

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Abstract

Objectives

To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the first wave of the COVID-19 pandemic in England compared with the general population.

Methods

We used Hospital Episode Statistics to identify all people alive on 1 March 2020 with ICD-10 codes for RAIRD from the whole population of England. We used linked national health records (demographic, death certificate, admissions and PCR testing data) to calculate rates of COVID-19 infection and death up to 31 July 2020. Our primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. General population data from Public Health England and the Office for National Statistics were used for comparison. We also describe COVID-19-related hospital admissions and all-cause deaths.

Results

We identified a cohort of 168 680 people with RAIRD, of whom 1874 (1.11%) had a positive COVID-19 PCR test. The age-standardized infection rate was 1.54 (95% CI: 1.50, 1.59) times higher than in the general population. A total of 713 (0.42%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardized mortality rate for COVID-19-related death was 2.41 (2.30–2.53) times higher than in the general population. There was no evidence of an increase in deaths from other causes in the RAIRD population.

Conclusions

During the first wave of COVID-19 in England, people with RAIRD had a 54% increased risk of COVID-19 infection and more than twice the risk of COVID-19-related death compared with the general population. These increases were seen despite shielding policies.

Article activity feed

  1. Version published to 10.1093/rheumatology/keab794
  2. Version published to 10.1101/2021.08.17.21260846v3 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.08.17.21260846: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Ethics: This study received a favourable opinion from the Camden and Kings Cross Research Ethics Committee, study reference 20/HRA/2076, on 18 June 2020.
    Sex as a biological variableAs the ESP is not disaggregated by sex and assumes equal numbers of males and females, and identical age distributions within sexes, this population was not used to calculate age-sex standardised rates.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: The measures of COVID-19 mortality described were selected to allow comparison with available statistics for the general population. Our primary definition, any mention of COVID-19 on the death certificate (used by the ONS), infers that COVID-19 infection contributed to death, even if it was not the main cause and even in the absence of a positive PCR test. This has the theoretical potential to over-estimate deaths due to COVID-19 infection but has been found to be the best measure to explain the excess deaths seen in the national data. In our RAIRD cohort, of the 713 people with a mention of COVID-19 on the death certificate, 661 (93%) had COVID-19 in part 1, meaning that it directly lead to death(22). Conversely, we may have underestimated COVID-19-related deaths as death certificate data were unavailable for 2% of our cohort. This proportion is not unexpected and registration delays are common(23), although they may disproportionately reflect certain groups such as deaths in hospital, or due to occupational exposure to disease (including COVID-19(24)). Our secondary definition was death within 28 days of a positive COVID-19 PCR test, as used by PHE. This measure overlooks deaths where the person never has a positive PCR test, or where the death occurred more than 28 days after diagnosis: important given the prolonged clinical course of COVID-19. In our RAIRD cohort, the median time between a positive test and death was 6 days, and only 22 (4%) of those who had...

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  4. Version published to 10.1101/2021.08.17.21260846v2 on medRxiv
  5. Version published to 10.1101/2021.08.17.21260846v1 on medRxiv