Rare autoimmune rheumatic diseases more than double risk for COVID-19 death
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Patients with rare autoimmune rheumatic diseases have a 54% increased risk for COVID-19 infection, and more than twice the risk for COVID-19 death, versus the general population, according to data published in Rheumatology.
“Our previous work has shown that people with rare autoimmune rheumatic diseases (RAIRD) were at increased risk of all-cause mortality during the first wave of the COVID-19 pandemic (March–April 2020), when compared with the general population in England,” Megan Rutter, MBBS, FRCP, of the University of Nottingham, in the United Kingdom, and colleagues wrote. “However, this study did not examine whether the increased mortality was due to COVID-19 infection itself, or due to indirect effects of the pandemic.”
To analyze the rates of COVID-19 infection and death in patients with rare autoimmune rheumatic diseases, compared with the general population, during the pandemic’s first wave in England, Rutter and colleagues studied linked national health records for the entire population. The researchers used Hospital Episode Statistics to identify all people alive on March 1, 2020, with ICD-10 codes for rare autoimmune rheumatic diseases throughout the entire population of England. They then used linked national health records — including demographic, death certificate, admissions and PCR testing data — to determine rates of COVID-19 infection and death up to July 31, 2020.
COVID-19 death was defined as the mention of COVID-19 on the death certificate. Comparison data from the general population were obtained from Public Health England and the Office for National Statistics. The study cohort included 168,680 patients with rare autoimmune rheumatic diseases, among whom 1,874 — or 1.11% — had a positive COVID-19 PCR test.
According to the researchers, the age-standardized infection rate among patients with rare autoimmune rheumatic diseases was 1.54 (95% CI, 1.5-1.59) times higher than that of the general population. In all, 0.42% of patients with rare autoimmune rheumatic disease died with COVID-19 listed on their death certificate. The mortality rate — standardized by age and sex — for COVID-19 death was 2.41 (95% CI, 2.3-2.53) times higher among those with rare autoimmune rheumatic disease than in the general population.
The researchers reported no evidence for an increase in deaths from other causes in those with rare autoimmune rheumatic diseases.
“This study shows that the increased mortality in people with rare autoimmune rheumatic diseases seen early in the pandemic was due to COVID-19 infection itself, rather than underlying rheumatic disease or comorbidities,” Rutter told Healio Rheumatology. “People with rare autoimmune rheumatic diseases were 50% more likely to have a positive COVID-19 PCR and 2.4 times more likely to die related to COVID-19 than people in the general population.”
“Comparing with the published literature, it would seem that they are at increased risk from COVID-19 compared to people with more common rheumatic diseases,” she added. “Many people with rare autoimmune rheumatic diseases require lifelong immunosuppression and they remain an at-risk group. Further research is required to understand the real-world effectiveness of COVID-19 vaccination in people with these conditions and on the impact of particular immunosuppressive therapies such as rituximab.”
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