tetano
Editor, Senior Moderator
Clin Infect Dis
. 2021 May 6;ciab407.
doi: 10.1093/cid/ciab407. Online ahead of print.
Risk Factors For Infection And Health Impacts Of The Covid-19 Pandemic In People With Autoimmune Diseases
Kathryn C Fitzgerald[SUP] 1 2 [/SUP], Christopher A Mecoli[SUP] 3 [/SUP], Morgan Douglas[SUP] 1 [/SUP], Samantha Harris[SUP] 1 [/SUP], Berna Aravidis[SUP] 1 [/SUP], Jemima Albayda[SUP] 3 [/SUP], Elias S Sotirchos[SUP] 1 [/SUP], Ahmet Hoke[SUP] 1 [/SUP], Ana-Maria Orbai[SUP] 3 [/SUP], Michelle Petri[SUP] 3 [/SUP], Lisa Christopher-Stine[SUP] 3 [/SUP], Alan N Baer[SUP] 3 [/SUP], Julie J Paik[SUP] 3 [/SUP], Brittany L Adler[SUP] 3 [/SUP], Eleni Tiniakou[SUP] 3 [/SUP], Homa Timlin[SUP] 3 [/SUP], Pavan Bhargava[SUP] 1 [/SUP], Scott D Newsome[SUP] 1 [/SUP], Arun Venkatesan[SUP] 1 [/SUP], Vinay Chaudhry[SUP] 1 [/SUP], Thomas E Lloyd[SUP] 1 [/SUP], Carlos A Pardo[SUP] 1 [/SUP], Barney J Stern[SUP] 1 [/SUP], Mark Lazarev[SUP] 4 [/SUP], Brindusa Truta[SUP] 1 [/SUP], Shiv Saidha[SUP] 1 [/SUP], Edward S Chen[SUP] 5 [/SUP], Michelle Sharp[SUP] 5 [/SUP], Nisha Gilotra[SUP] 6 [/SUP], Edward K Kasper[SUP] 6 [/SUP], Allan C Gelber[SUP] 2 3 [/SUP], Clifton O Bingham[SUP] 3 [/SUP], Ami A Shah[SUP] 3 [/SUP], Ellen M Mowry[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: People with autoimmune or inflammatory conditions taking immunomodulatory/suppressive medications may have higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences.
Methods: We included participants with autoimmune or inflammatory conditions followed by specialists at Johns Hopkins. Participants completed periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. We assessed whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterized pandemic-associated changes to care and mental health.
Results: 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medications) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in models incorporating behavior and other potential confounders (OR: 1.43; 95%CI: 1.08, 1.89). Other medication classes were not associated with COVID-19 risk. Diabetes (OR: 1.72; 95%CI: 1.08, 2.73), cardiovascular disease (OR: 1.68; 95%CI: 1.24, 2.28), and kidney disease (OR: 1.76; 95%CI: 1.04, 2.97) were associated with higher odds of COVID-19. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions therein, which disproportionately affected individuals experiencing changes to employment or income.
Conclusions: Glucocorticoid exposure may increase risk of COVID-19 in people with autoimmune or inflammatory conditions. Disruption to healthcare and related services was common. Those with pandemic-related reduced income may be most vulnerable to care disruptions.
. 2021 May 6;ciab407.
doi: 10.1093/cid/ciab407. Online ahead of print.
Risk Factors For Infection And Health Impacts Of The Covid-19 Pandemic In People With Autoimmune Diseases
Kathryn C Fitzgerald[SUP] 1 2 [/SUP], Christopher A Mecoli[SUP] 3 [/SUP], Morgan Douglas[SUP] 1 [/SUP], Samantha Harris[SUP] 1 [/SUP], Berna Aravidis[SUP] 1 [/SUP], Jemima Albayda[SUP] 3 [/SUP], Elias S Sotirchos[SUP] 1 [/SUP], Ahmet Hoke[SUP] 1 [/SUP], Ana-Maria Orbai[SUP] 3 [/SUP], Michelle Petri[SUP] 3 [/SUP], Lisa Christopher-Stine[SUP] 3 [/SUP], Alan N Baer[SUP] 3 [/SUP], Julie J Paik[SUP] 3 [/SUP], Brittany L Adler[SUP] 3 [/SUP], Eleni Tiniakou[SUP] 3 [/SUP], Homa Timlin[SUP] 3 [/SUP], Pavan Bhargava[SUP] 1 [/SUP], Scott D Newsome[SUP] 1 [/SUP], Arun Venkatesan[SUP] 1 [/SUP], Vinay Chaudhry[SUP] 1 [/SUP], Thomas E Lloyd[SUP] 1 [/SUP], Carlos A Pardo[SUP] 1 [/SUP], Barney J Stern[SUP] 1 [/SUP], Mark Lazarev[SUP] 4 [/SUP], Brindusa Truta[SUP] 1 [/SUP], Shiv Saidha[SUP] 1 [/SUP], Edward S Chen[SUP] 5 [/SUP], Michelle Sharp[SUP] 5 [/SUP], Nisha Gilotra[SUP] 6 [/SUP], Edward K Kasper[SUP] 6 [/SUP], Allan C Gelber[SUP] 2 3 [/SUP], Clifton O Bingham[SUP] 3 [/SUP], Ami A Shah[SUP] 3 [/SUP], Ellen M Mowry[SUP] 1 2 [/SUP]
Affiliations
- PMID: 33956972
- DOI: 10.1093/cid/ciab407
Abstract
Background: People with autoimmune or inflammatory conditions taking immunomodulatory/suppressive medications may have higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences.
Methods: We included participants with autoimmune or inflammatory conditions followed by specialists at Johns Hopkins. Participants completed periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. We assessed whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterized pandemic-associated changes to care and mental health.
Results: 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medications) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in models incorporating behavior and other potential confounders (OR: 1.43; 95%CI: 1.08, 1.89). Other medication classes were not associated with COVID-19 risk. Diabetes (OR: 1.72; 95%CI: 1.08, 2.73), cardiovascular disease (OR: 1.68; 95%CI: 1.24, 2.28), and kidney disease (OR: 1.76; 95%CI: 1.04, 2.97) were associated with higher odds of COVID-19. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions therein, which disproportionately affected individuals experiencing changes to employment or income.
Conclusions: Glucocorticoid exposure may increase risk of COVID-19 in people with autoimmune or inflammatory conditions. Disruption to healthcare and related services was common. Those with pandemic-related reduced income may be most vulnerable to care disruptions.