Racial, ethnic minorities with rheumatic disease, COVID-19 more likely to be hospitalized
Black and Hispanic patients with rheumatic diseases plus COVID-19 were more likely to require hospitalization and mechanical ventilation to treat their infections compared with white patients, according to data presented at ACR 2020.
“As COVID-19 spread across the world earlier this spring, it became clear that the disease was impacting certain groups more than others,” Milena Gianfrancesco, PhD, MPH, assistant professor at the University of California, San Francisco School of Medicine, said during a press conference. “Growing attention to research began to illustrate the disproportionate burden of COVID-19 among racial and ethnic minorities in the United States.”
“We know that patients with rheumatic diseases and those on immunosuppressive medications have a higher risk of developing severe infections,” she added. “COVID-19 became a concern very early on in the pandemic for this patient population. Further, racial and ethnic minorities with rheumatic disease generally experience a higher burden of disease risk and severity compared to white patients. The disproportionate adverse outcomes of COVID-19 could have substantial long-term impact on patients’ health and quality of life.”
To assess the link between race/ethnicity and COVID-19 hospitalization, ventilation requirements and COVID-19-related mortality in patients with rheumatic disease, Gianfrancesco and colleagues examined a cohort of patients (n=694) from the global rheumatology registry from March 24 to May 22.
Patients were defined as white, Black, Hispanic or other race/ethnicity and controlled for age, sex, smoking status and rheumatic disease diagnoses, which included rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis and others. The researchers also controlled data for common morbidities, including cardiovascular disease, hypertension, lung disease, diabetes and chronic renal insufficiency or end-stage renal disease. Gianfrancesco and colleagues also evaluated arthritis medications in use among patients, including immunosuppressants.
The researchers used multivariable logistic regression was used to estimate ORs and 95% CIs for hospitalization; ordinal logistic regression was used to estimate ORs and 95% CIs of ventilatory support; and Poisson models were used to estimate ORs and 95% CIs of mortality.
According to study results, Black and Hispanic patients with rheumatic diseases plus COVID-19 had 2.7 and 1.98 higher odds, respectively, of requiring hospitalization for COVID-19 compared with whites. Additionally, these populations exhibited threefold increased odds of requiring ventilation support compared with whites. The researchers, however, reported no differences in mortality rates based on race or ethnicity.
“Similar to findings in the general population, we found that racial/ethnic minority patients with rheumatic diseases had increased odds of hospitalization and ventilatory support,” Gianfrancesco said. “These disparities may be due to several factors: access to testing, access to care, living/working environments and living in densely populated homes. It’s very likely that the disparities we witnessed in COVID-19 outcomes reflect preexisting, underlying health disparities in our population.”
She added: “Bringing these results to light will hopefully lead to actual changes within the rheumatology community and beyond. We need to be sure that patients who are high risk of severe outcomes have access to testing, treatment and the vaccine. Rheumatology providers can and should be advocates for their patients and a trusted ally.”
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Gianfrancesco M. Abstract #0006. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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