Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases.
Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases.
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DOI：
10.1093/cid/ciab407
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发表时间：
2022-02-11
期刊：
影响因子：
--
通讯作者：
Mowry EM
中科院分区：
文献类型：
--
作者：
Fitzgerald KC;Mecoli CA;Douglas M;Harris S;Aravidis B;Albayda J;Sotirchos ES;Hoke A;Orbai AM;Petri M;Christopher-Stine L;Baer AN;Paik JJ;Adler BL;Tiniakou E;Timlin H;Bhargava P;Newsome SD;Venkatesan A;Chaudhry V;Lloyd TE;Pardo CA;Stern BJ;Lazarev M;Truta B;Saidha S;Chen ES;Sharp M;Gilotra N;Kasper EK;Gelber AC;Bingham CO;Shah AA;Mowry EM
患有自身免疫性或炎症性疾病的人服用免疫调节/抑制药物可能会有更高的风险患上2019年新型冠状病毒病(新冠肺炎)。许多患者的慢性病护理也发生了变化，下游后果不确定。我们包括患有自身免疫性或炎症性疾病的参与者，随后是约翰·霍普金斯大学的专家。参与者完成了定期调查，询问合并症、疾病修改药物、暴露、新冠肺炎测试和结果、社会行为以及医疗保健中断。我们评估了服用免疫调节剂或抑制剂的患者中新冠肺炎的风险是否更高，并表征了大流行相关的护理和心理健康变化。总共有265人(5.6%)在9个月的随访期(2020年4月至12月)期间开发了新冠肺炎。患者特征(年龄、种族、共病、药物)与大流行期间社会疏远行为的差异有关。在包含行为和其他潜在混杂因素的模型中，接触糖皮质激素与新冠肺炎的风险较高相关(优势比[OR]：1.43；95%可信区间[CI]：1.08，1.89)。其他药物类别与新冠肺炎风险无关。糖尿病(OR：1.72；95%CI：1.08，2.73)、心血管疾病(OR：1.68；95%CI：1.24，2.28)和肾脏疾病(OR：1.76；95%CI：1.04，2.97)与新冠肺炎的发病风险相关。在大流行前报告使用输液、心理健康或康复服务的2156人中，975人(45.2%)报告了其中的中断，这对经历就业或收入变化的个人造成了不成比例的影响。糖皮质激素暴露可能会增加患有自身免疫性或炎症性疾病的人患新冠肺炎的风险。医疗保健和相关服务的中断很常见。那些与大流行相关的收入减少的人可能最容易受到护理中断的影响。对患有自身免疫性或炎症性疾病的人进行的一项大型研究发现，接触糖皮质激素可能会增加2019年患冠状病毒病的风险(新冠肺炎)。研究还表明，在这一人群中，那些与大流行相关的收入或就业减少的人最容易受到护理中断的影响。
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. 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. In total, 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 (odds ratio [OR]: 1.43; 95% confidence interval [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. 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. A large study of people with autoimmune or inflammatory conditions finds that glucocorticoid exposure may increase risk of coronavirus disease 2019 (COVID-19). The study also suggests that in this population, those with pandemic-related reduced income or employment were most vulnerable to care disruptions.
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