Obesity drives risk for COVID-19 among Latino patients with rheumatic disease
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Latino patients with rheumatic disease have a high rate of COVID-19, with obesity identified as a key risk factor for infection, which, in turn, was linked to increased risk for rheumatic disease flare, according to data.
“Latino individuals have been reported to have a higher incidence and a severe COVID-19 illness,” Alice Fike, MSN, of the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), told Healio Rheumatology. “Interestingly, we observed an even higher incidence rate, but mild COVID-19 illness, in our majority Latino cohort of patients, with no associated mortality.”
According to Fike and colleagues, Latinos living in the United States not only have a higher prevalence of obesity, diabetes, and kidney diseases, but also have lower rates of insurance coverage than the general population.
“Latinos are more likely to work in positions considered to be essential thus increasing their risk for exposure to infections,” the researchers wrote in Arthritis & Rheumatology. “Such jobs often provide limited or no sick time, further perpetuating this increased risk to Latino workers. The combination of these factors has led to Latino patients being disproportionately impacted by COVID-19, resulting in increased incidence, severity of disease and mortality.”
To analyze the clinical features and outcomes of COVID-19 among Latino patients with rheumatic diseases, Fike and colleagues conducted a retrospective study of an existing observational cohort at the NIAMS Intramural Research Program, in Washington, D.C. This cohort included 307 active participants with rheumatic diseases who were referred to the NIAMS clinic from federally qualified health centers.
For their own study, Fike and colleagues identified 32 cohort patients — all of whom self-reported Latino ethnicity — with COVID-19 during the study period of April 2020 to Oct. 15, 2020. For the comparator group, the researchers included 146 Latino patients from the NIAMS cohort who were seen during the study period and asymptomatic for, and denied exposure to, COVID-19. However, these comparator patients had not been tested for COVID-19. Fike and colleagues analyzed demographics, BMI, comorbidities and immunomodulatory therapies for all included participants. In addition, they used an exploratory classification and regression tree (CART) and logistic regression analyses to identify risk factors for COVID-19 and rheumatic disease flare.
According to the researchers, the cohort’s COVID-19 incidence rate was 17,978 per 100,000, which was three-fold higher than the 4,689 to 5,809 per 100,000 incidence rate observed among Latino residents, and five- to 11-fold higher than the rate of 1,540 to 3,431 per 100,000 for the general population — both within the local catchment areas during the study period. However, no patients with COVID-19 required ICU-level care. All patients with COVID-19 were either classified as essential workers or lived in a household with essential workers.
Using the CART and logistic regression analyses, the researchers found that a BMI of more than 30.35 was a risk factor for COVID-19 (OR = 3.37; 95% CI, 1.5-7.7). In addition, COVID-19 infection was identified as a risk factor for rheumatic disease flare (OR = 4.57; 95% CI, 1.2-17.4).
“The incidence of COVID-19 in Latino patients with rheumatic disease was three times higher compared with Latinos in the general population,” Fike said. “There was an association between obesity and the risk of COVID-19 illness in our study, as well as an association between COVID-19 illness and subsequent rheumatic disease flare that was unrelated to stopping anti-rheumatic drugs during the infection.”
Coauthor Pravitt Gourh, MD, of NIAMS and the National Institute on Minority Health and Health Disparities at NIH, advised providers to counsel their patients with obesity regarding their potentially increased risk.
“Latinos with rheumatic diseases have an increased risk for developing COVID-19 illness and a subsequent rheumatic disease flare,” Gourh told Healio Rheumatology. “Thus, rheumatologists should monitor patients post-COVID-19 infection and also counsel obese patients that they may be at an increased risk for COVID-19 illness.”
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