Rural patients with AIRDs have 24% higher post-COVID mortality risk vs urban population
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Key takeaways:
- Patients with AIRDs in rural areas had a 24% higher mortality risk over 2 years post-infection vs. patients in urban areas.
- Glucocorticoid, immunosuppressant and rituximab use increased mortality risk.
Patients with autoimmune or inflammatory rheumatic diseases living in rural areas demonstrate a 24% higher mortality risk after SARS-CoV-2 infection vs. those in urban areas, according to data published in Arthritis Care & Research.
“People living in rural regions in the United States face unique health challenges, including during the COVID-19 pandemic when higher rates of post-COVID-19 mortality were observed, particularly in the delta and omicron periods,” A. Jerrod Anzalone, PhD, of the University of Nebraska Medical Center, and colleagues wrote. “These challenges, collectively called the rural mortality penalty, include shorter life expectancies, greater socioeconomic disparities, greater prevalence of comorbid health conditions and long-standing issues in health care and economic challenges.
“Limited real-world evidence exploring the rural mortality penalty in people with [autoimmune or inflammatory rheumatic diseases (AIRDs)] exists, and none have looked at the long-term impact of SARS-CoV-2 infection on mortality among rural versus urban people with AIRD,” they added.
To investigate rural vs. urban mortality after COVID-19 in patients with AIRDs, Anzalone and colleagues conducted a retrospective study of patient records in the National COVID Cohort Collaborative. The analysis included 86,467 adults (median age, 60 years) with one or more AIRD, such as rheumatoid arthritis or psoriatic arthritis, and a documented SARS-CoV-2 infection from April 2020 through March 2023.
The researchers referred to patients’ residential ZIP codes to determine rural or urban geography. The relationships between rural vs. urban residence and all-cause mortality in the 2 years after a COVID-19 infection were assessed using multivariable Cox proportional hazards models, with inverse probability of treatment weighting.
According to the researchers, the 2-year mortality rate among urban dwellers was 6% vs. 8.5% in rural dwellers. Compared with urban dwellers, those in rural areas demonstrated a 24% higher risk for all-cause mortality in the 2 years after SARS-CoV-2 infection (adjusted HR = 1.24; 95% CI, 1.19-1.29).
Prescription medications associated with an increased mortality risk included glucocorticoids (adjusted HR = 1.24; 95% CI, 1.17-1.32), immunosuppressants (adjusted HR = 1.24; 95% CI, 1.13-1.36) and rituximab (Rituxan, Genentech) (adjusted HR = 1.21; 95% CI, 1.05-1.4). Risk decreased with use of conventional synthetic disease-modifying antirheumatic drugs such as methotrexate (adjusted HR = 0.9; 95% CI, 0.84-0.97), or biologic DMARDs (adjusted HR = 0.85; 95% CI, 0.76-0.94).
“Policymakers and health care systems need to take this rural-urban disparity into account as they develop and implement policies and programs to mitigate the influence of COVID-19,” Anzalone and colleagues wrote. “More studies are needed to examine the mediators of this geographic disparity in survival, such as access to health care and drivers of social inequities in rural communities, including educational level, employment, environmental exposures, and area-level and individual poverty.
“A better knowledge of mediators of rural-urban disparities can allow the development of programs and interventions that target any identified modifiable mediators and help to improve outcomes following SARS-CoV-2 infection in rural populations with rheumatic diseases,” they added.
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