Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic
Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic
复制标题
2020 年 COVID-19 大流行期间，罕见自身免疫性疾病患者与英格兰普通人群相比的死亡风险
作者：
E. Peach;M. Rutter;P. Lanyon;M. Grainge;R. Hubbard;J. Aston;M. Bythell;Sarah Stevens;F. Pearce
摘要目标量化英国2020年COVID-19大流行期间罕见自身免疫性风湿病（RAIRD）患者与普通人群以及与新冠疫情前风险相比的死亡风险。方法：我们进行了一项队列研究，2003年英格兰医院事件统计，并从NHS个人人口统计服务链接的数据。我们使用ONS公布的一般人群死亡率数据。结果我们纳入了168691名在2020年3月1日记录诊断为RAIRD的人。他们的中位年龄为61.7（IQR 41.5-75.4）岁，118379（70.2%）为女性。我们的病例确定方法的阳性预测值为85%。1，815名（1.1%）参与者在2020年3月和4月期间死亡。RAIRD患者的年龄标准化死亡率（ASMR）（3669.3，95%CI 3500.4-3838.1/10万人年）比前5年相同月份的平均ASMR高1.44倍（95%CI 1.42-1.45），而在英格兰的一般人群中，ASMR高1.38倍。与新冠肺炎前相比，RAIRD患者的特定死亡率从35岁以上开始升高，而在一般人群中，风险从55岁以上开始增加。与男性相比，女性在COVID-19期间的死亡率增幅更大。结论在COVID-19期间，RAIRD患者的全因死亡风险比普通人群更显著增加。我们迫切需要量化COVID-19感染造成的风险有多大，以及医疗服务中断造成的风险有多大。
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.