Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 COVID-19 pandemic

Abstract

Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4–3838.1 per 100 000 person-years) was 1.44 (95% CI 1.42–1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.

Epidemiology and Clinical Management of Rheumatic Autoimmune Diseases in the COVID-19 Pandemic: A Review

“…The majority of RADs patients infected with COVID-19 were female ( 4 , 5 , 15 , 18 , 20 , 22 , 23 , 25 , 28 – 32 ), generally exceeding 60%, with an average of 70.86% ( Figure 2 ). The overall mortality during COVID-19 development was higher in female RADs patients ( 11 ), which is different from the situation in non-RAD population that male accounts for a greater proportion. However, there were also other studies reporting that male could be an independent factor associated with the severity of COVID-19, for male RADs patients may have worse prognosis, higher hospitalization rate and risk of severe pneumonia ( 22 , 28 ).…”

“…Similarly, Italy, one of the European countries hardest hit by the outbreak, has a significantly higher prevalence of COVID-19 among the RADs population than in the general population ( 1 ). In England, a study involving 168,691 subjects adopted an index of age-standardized mortality rate (ASMR), and identified a higher risk of COVID-19 infection in RADs population ( 11 ). According to a nationwide cohort study from Denmark, RADs patients had an increased COVID-19 associated hospitalization rate, compare to 4.5 million general population ( 12 ).…”

“…But what is noteworthy is that the incidence of COVID-19 skewed toward a younger crowd gradually. Upon COVID-19 infection, age-specific mortality rates in RADs patients notably increased from the age of 35 years old, while in the uninfected population, this indicator began from the age of 55 years old ( 11 ).…”

Problems of early diagnosis of systemic lupus erythematosus during the COVID-19 pandemic

“…В то же время клинические данные, касающиеся риска инфицирования SARS-CoV-2 и влияния СКВ на исходы COVID-19, противоречивы [70][71][72]. Создается впечатление, что пациенты с СКВ и «аутоиммунными» ИВРЗ составляют группу риска в отношении заболеваемости и тяжелого течения COVID-19, в то время как эффективная противовоспалительная терапия (за исключением глюкокортикоидов и анти-В-клеточных моноклональных антител -ритуксимаба) не оказывает влияния на исходы инфекции SARS-CoV-2 и даже может способствовать более «мягкому» течению COVID-19 [73][74][75][76].…”

2019 Coronavirus disease (COVID-19): contribution of rheumatology

“…В контексте «ревматологических» проблем СOVID-19 следует обратить внимание на то, что у пациентов с ИВРЗ неконтролируемое воспаление, иммуносупрессивная терапия, коморбидная патология, генетические и другие факторы потенциально могут приводить к увеличению «чувствительности» к вирусным и бактериальным инфекциям, в том числе к SARS-CoV-2 [21]. Однако данные, касающиеся риска инфицирования вирусом SARS-CoV-2 и исходов у пациентов с ИВРЗ, заболевшими COVID-19, противоречивы [22][23][24][25][26][27][28]. Предполагается, что в рамках ИВРЗ именно пациенты с СЗСТ составляют группу риска в отношении заболеваемости и тяжелого течения COVID-19, в то время как противовоспалительная терапия, применяемая при РА, спондилоартрите и ПсА (за исключением глюкокортикоидов -ГК -в высоких дозах), не оказывает влияния или может способствовать более «мягкому» течению COVID-19 [29].…”