Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality.
Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality.
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DOI：
10.1093/rheumatology/keac283
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发表时间：
2022-06-28
期刊：
影响因子：
5.5
通讯作者：
Choy, Ernest
中科院分区：
文献类型：
--
作者：
Cooksey, Roxanne;Underwood, Jonathan;Brophy, Sinead;Atkinson, Mark;Kennedy, Jonathan;Choy, Ernest
调查患有炎症性关节炎（IA）的个人，他们的治疗和屏蔽状态是否会影响英国威尔士整个人口的COVID-19不良后果风险。回顾性、基于人群的队列研究，使用来自SAIL数据库的链接、匿名电子健康数据，包括初级/二级保健、风湿病学、国家统计局死亡率和COVID-19实验室数据。研究病例为于2020年3月至2021年5月期间COVID-19检测呈阳性且存在类风湿性关节炎、银屑病关节炎和强直性脊柱炎READ代码的18岁及以上个体。共有1966名IA患者和166602名非IA患者的COVID-19检测呈阳性。IA的发病率为3.5%（1966/56 914），而一般人群为6%（166 602/2 760 442），（差异：2.5%，95% CI：2.4%，2.7%，P ≤0.001）。在校正的考克斯比例风险模型中，IA与较高的死亡率无关（HR：0.56，95% CI：0.18，1.64，P=0.286）。重要的风险因素包括屏蔽（HR：1.52，95% CI：1.40，1.64，P ≤0.001），因既往感染住院（HR：1.20，95% CI：1.12，1.28，P ≤0.001），大流行前1年住院（HR：1.34，95% CI：1.25，1.44，P ≤0.001）和糖皮质激素使用（HR：1.17，95% CI：1.09，1.25，P ≤0.001）。IA患者的COVID-19发病率较低，可能是由于屏蔽。IA与COVID-19感染后死亡率增加无关;易感（屏蔽）、合并症和其他因素与风险增加相关。这些关键风险因素可以识别出患有IA的个人，他们面临着更大的COVID-19风险，并建议在社区高流行期间进行防护。
Investigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK. Retrospective, population-based cohort study using linked, anonymized electronic health data from SAIL Databank, including primary/secondary care, rheumatology, Office for National Statistics Mortality and COVID-19 laboratory data. Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases. A total of 1966 people with IA and 166 602 without tested positive for COVID-19. The incidence rate was 3.5% (1966/56 914) in IA, vs 6% in the general population (166 602/2 760 442), (difference: 2.5%, 95% CI: 2.4%, 2.7%, P ≤0.001). In an adjusted Cox proportional hazard model, IA was not associated with higher mortality (HR: 0.56, 95% CI: 0.18, 1.64, P=0.286). Significant risk factors included shielding (HR: 1.52, 95% CI: 1.40, 1.64, P ≤0.001), hospitalization for previous infections (HR: 1.20, 95% CI: 1.12, 1.28, P ≤0.001), hospitalizations one year pre-pandemic (HR: 1.34, 95% CI: 1.25, 1.44, P ≤0.001) and glucocorticoid use (HR: 1.17, 95% CI: 1.09, 1.25, P ≤0.001). Individuals with IA had a lower incidence of COVID-19, probably due to shielding. IA was not associated with increased mortality following COVID-19 infection; being vulnerable (shielded), comorbidities and other factors were associated with increased risk. These key risk factors can identify individuals with IA at greater risk from COVID-19 and advised to shield during high community prevalence.
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