Older age, comorbidities associated with COVID-19 hospitalization, death in IMIDs
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Patients with immune-mediated inflammatory disease and COVID-19 who are older and have pulmonary or cardiovascular comorbidities demonstrate increased hospitalization and death, according to data presented at EULAR 2022 Congress.
Philip J. Mease, MD, of Swedish Medical Center, in Seattle, and colleagues identified patients with COVID-19 from a health system that serves seven U.S. states between Alaska and Texas. Data for approximately 9 million patients in the health system underwent analysis. This included 270,000 patients with immune-mediated inflammatory diseases (IMIDs).
Hospitalization and death within 30 days of COVID-19 incidence served as the primary outcome measure.
The researchers analyzed data from two different time periods. The first was from March 1, 2020, through Dec. 25, 2021 — which Mease noted was before the omicron variant began circulating — and the second was from Dec. 26, 2021, through April 13, 2022.
The analysis included an assessment of immunomodulatory drug use for 3 months prior to the index date, according to Mease.
In the first cohort, among more than 162,000 positive COVID-19 cases overall, 6,185 were among patients with IMIDs. The COVID-19 hospitalization rates were 2.4% in individuals without IMIDs and 3% for those with IMIDs. Similarly, mortality rates were 3.1% in the non-IMID group and 4.5% in the IMID group.
“[These were] higher rates than the overall population,” Mease said.
Data for the second cohort demonstrated more than 68,000 positive COVID-19 cases overall, with 2,995 of those cases occurring in individuals with IMIDS. Hospitalization rates were 0.4% in the non-IMID group and 1.5% in the IMID group. Mortality was reported in 1.7% of non-IMID patients and 3.2% of the IMID group.
“Again, during this time period, people with IMIDs had increased hospitalization and death compared to non-IMID patients,” Mease said.
The researchers conducted a multivariate analysis that included a broad cross-section of demographic information, disease-related factors and comorbidities.
“In both time periods, increasing age and comorbidities were associated with hospitalization and death,” Mease said.
Some of the comorbidities described by Mease included coronary artery disease, heart failure, diabetes, chronic kidney disease and COPD.
Rheumatoid arthritis, psoriasis and inflammatory bowel disease were the most commonly occurring IMIDs in the study population, with smaller numbers of patients with lupus, spondyloarthritis, vasculitis and other conditions.
“Most IMIDs were not associated with hospitalization and death in either time period,” Mease said. “Although spondyloarthritis and Sjögren’s syndrome were associated with decreased mortality in the second time period.”
Mease added that most IMID therapies — including TNF inhibitors, Janus kinase inhibitors, a cross section of interleukin inhibitors and disease-modifying antirheumatic drugs — were not associated with the outcomes of interest in this study cohort.
“In the second time period, oral small molecules were associated with increased mortality, while TNF inhibitors were favorably associated with lesser rates of death,” he said.
The researchers also included information regarding COVID-19 vaccinations.
“More patients were vaccinated and boosted in the second time period, but nonetheless the majority of people testing positive in both groups were unvaccinated,” Mease said. “In both time periods, vaccination and booster were associated with less hospitalization and death.”
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Mease PJ. Risk factors for severe COVID-19 outcomes: A study of immune-mediated inflammatory diseases, therapies and comorbidities in a large U.S. healthcare system. Presented at: EULAR 2022 Congress; June 1-4, 2022 (virtual meeting).
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