Incident autoimmune diseases in association with a SARS-CoV-2 infection: A matched cohort study

Abstract

ObjectivesTo investigate whether the risk of developing an incident autoimmune disease is increased in patients with previous COVID-19 disease compared to people without COVID-19.MethodA cohort was selected from German routine health care data covering 38.9 million individuals. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through December 31, 2020. Patients were matched 1:3 to control patients without COVID-19. Both groups were followed up until June 30, 2021. We used the four quarters preceding the index date until the end of follow-up to analyze the onset of autoimmune diseases during the post-acute period. Incidence rates (IR) per 1000 person-years were calculated for each outcome and patient group. Poisson models were deployed to estimate the incidence rate ratios (IRRs) of developing an autoimmune disease conditional on a preceding diagnosis of COVID-19.ResultsIn total, 641,704 patients with COVID-19 were included. Comparing the incidence rates in the COVID-19 (IR=15.05, 95% CI: 14.69-15.42) and matched control groups (IR=10.55, 95% CI: 10.25-10.86), we found a 42.63% higher likelihood of acquiring autoimmunity for patients who had suffered from COVID-19. This estimate was similar for common autoimmune diseases, such as Hashimoto thyroiditis, rheumatoid arthritis, or Sjögren syndrome. The highest IRR was observed for autoimmune disease of the vasculitis group. Patients with a more severe course of COVID-19 were at a greater risk for incident autoimmune diseases.ConclusionsSARS-CoV-2 infection is associated with an increased risk of developing new-onset autoimmune diseases after the acute phase of infection.

High risk of autoimmune diseases after COVID-19

“…They also highlighted the detection of various autoantibodies in individuals with COVID-19 (such as antinuclear antibodies, lupus anticoagulant cold agglutinins and anti-Ro/SSA antibodies) that are also seen in autoimmune conditions. The reports by Chang et al 2 and Tesch et al 3 provide a comprehensive overview of diverse new-onset autoimmune conditions after COVID-19. In addition, an earlier preprint of a retrospective matched cohort analysis using data from the Clinical Practice Research Datalink Aurum database of 458,147 SARS-CoV-2-infected and 1,818,929 uninfected adults across England between 31 January 2020 and 30 June 2021 reported that the incidence of type 1 diabetes mellitus, inflammatory bowel disease and psoriasis are significantly associated with SARS-CoV-2 infection 9 .…”

“…Owing to worldwide vaccination efforts, mortality due to COVID-19 has been decreasing, but we continue to witness considerable morbidity and increased rates of post-COVID-19 conditions and in particular, new-onset autoimmune and inflammatory diseases in individuals who have had COVID-19. The range and incidence of these post-COVID-19 disorders have now been highlighted in two large retrospective cohort studies 2,3 . Some of the earliest evidence that SARS-CoV-2 infection leads to dysregulated immune responses came from paediatric patients who presented with multisystem inflammatory syndrome in children (MIS-C), which, as the name indicates, involves diffuse organ system involvement and a clinical spectrum that overlaps with other hyperinflammatory syndromes, such as Kawasaki disease, toxic-shock syndrome, and macrophage activation syndrome 4 .…”

“…Lack of data from a large cohort of individuals was the main stumbling block to precisely understanding these facts. Using electronic health record data from large cohorts of individuals, Chang et al 2 and Tesch et al 3 attempted to fill this important gap.…”

“…3 , which has not yet been peerreviewed, evaluated a cohort of 640,701 vaccination-naive individuals with PCR-confirmed COVID-19 during 2020 for the risk of autoimmune conditions. The researchers identified a 42.6% higher likelihood of acquiring an autoimmune condition 3-15 months after infection compared with a non-COVID-19 cohort of 1,560,357 individuals matched for age, sex and whether they had a preexisting autoimmune disease 3 . The highest incidence rate ratios were found for vasculitis conditions, which are relatively rare autoimmune diseases.…”

Das Gesundheitsdatennutzungsgesetz – Potenzial für eine bessere Forschung und Gesundheitsversorgung

“…Ein Beispiel ist eine aktuelle Untersuchung zur Häufung von Autoimmunerkrankungen nach einer COVID-19-Infektion, an der durch Beteiligung zahlreicher Krankenkassen und des Robert Koch-Instituts Daten von über 39 Millionen GKV-Versicherten einbezogen werden konnten 26 . Die vom Bundesministerium für Gesundheit unterstützte Studie wurde im Januar 2023 auf einem Preprint-Server publiziert.…”