Different COVID-19 outcomes among systemic rheumatic diseases: a nation-wide cohort study

  1. Vasiliki-Kalliopi Bournia
  2. George E Fragoulis
  3. Panagiota Mitrou
  4. Konstantinos Mathioudakis
  5. Anastasios Tsolakidis
  6. George Konstantonis
  7. Ioulia Tseti
  8. Georgia Vourli
  9. Maria G Tektonidou
  10. Dimitrios Paraskevis
  11. Petros P Sfikakis

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Abstract

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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  1. Version published to 10.1093/rheumatology/keac422
  2. ScreenIT

    SciScore for 10.1101/2022.03.11.22271887: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationStudy Population: In this nationwide, population-based cohort study we identified all adult patients with RA, AS, PsA, SLE, and SSc alive on 1-March-2020 and matched each patient to 5 random referents from the general population for gender, age and region of domicile.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis was performed using the Stata statistical software package (StataCorp. 2013. Stata Statistical
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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:
    This important limitation should be taken in account when interpreting these findings, given the high frequency of comorbidities among patients with systemic rheumatic disease[6–12] and the strong influence that comorbidities and disease activity exert on Covid-19 associated outcomes in this patient population[16, 17]. Regarding the risk of Covid-19 infection, with the exception of AS patients, all other patient subgroups were at higher risk, in agreement also with a general population-based cohort study[18]and two recent-metanalyses[4, 5]. However, the possibility that these patients were more susceptible to increased rates of testing cannot be excluded. Therefore, whether a tendency to contract the infection more easily, together with the increased comorbidity burden, can explain the higher Covid-19 associated death risk found collectively in systemic rheumatic disease patients compared to the general population needs further study[19]. As regards to hospitalization rates, there are three nation-wide studies from Sweden[14], Denmark[20] and Iceland[21], in line with our findings, while two meta-analyses[4, 5] report different results on this matter. This could be interpreted in light of several differences between countries, such as local guidelines, intensity of pandemic wave, saturation level of health care system, access to healthcare facilities and other confounders[22]. Increased hospitalization rates could be possibly also due, at least in part, to lower threshold for...

    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.

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  3. Version published to 10.1101/2022.03.11.22271887v1 on medRxiv