Risk of COVID-19 in Rheumatoid Arthritis: A National Veterans Affairs Matched Cohort Study in At-Risk Individuals
Risk of COVID-19 in Rheumatoid Arthritis: A National Veterans Affairs Matched Cohort Study in At-Risk Individuals
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DOI：
10.1002/art.41800
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发表时间：
2021-10-19
影响因子：
13.3
通讯作者：
Mikuls, Ted R.
中科院分区：
文献类型：
--
作者：
England, Bryant R.;Roul, Punyasha;Mikuls, Ted R.
目的风湿性关节炎（RA）及其治疗与感染风险增加有关，但目前尚不清楚这些因素是否对COVID-19的风险或严重程度产生影响。本研究旨在评估美国退伍军人事务部（VA）RA患者和非RA患者队列中COVID-19的风险和严重程度。方法采用全国VA资料进行配对队列研究。被诊断为RA的患者是在截至2020年1月1日在VA医疗保健系统中活跃并于2019年在VA医疗中心接受治疗的非死亡个体中确定的;没有RA诊断代码的患者按年龄，性别和VA部位（非RA对照）与RA患者（1：1）匹配。确诊为COVID-19的患者和严重COVID-19患者（定义为需要住院或导致死亡）是从VA COVID-19全国监测数据库中确定的，直至2020年12月10日。多变量考克斯模型用于比较RA患者和非RA对照之间COVID-19和COVID-19住院或死亡的风险，调整人口统计学特征、合并症、医疗保健利用和获得以及县级COVID-19发病率后。结果RA患者和非RA对照的VA队列（每组n = 33，886例受试者）主要包括男性患者（84.5%），平均年龄为67.8岁。在随访期间，队列中有1，503名患者被诊断为COVID-19;其中，388名患者患有严重的COVID-19（住院或死亡），而在228名患者中，死亡与COVID-19无关。在多变量模型中，与非RA对照组相比，RA与COVID-19的更高风险（校正的风险比[HR] 1.25 [95%置信区间（95% CI）1.13-1.39]）和COVID-19住院或死亡的更高风险（校正的HR 1.35 [95% CI 1.10-1.66]）相关。使用缓解疾病的抗风湿药物和泼尼松，以及自我报告的黑人种族，自我报告的西班牙裔种族，以及存在几种慢性疾病，但RA自身抗体血清阳性，均与COVID-19和严重COVID-19（住院或死亡）的风险相关。结论与非RA患者相比，RA患者发生COVID-19和严重COVID-19（导致住院或死亡）的风险更高。由于COVID-19的风险接近其他公认的慢性疾病，这些发现表明RA患者应优先考虑COVID-19预防和管理策略。
Objective Rheumatoid arthritis (RA) and its treatments are associated with an increased risk of infection, but it remains unclear whether these factors have an impact on the risk or severity of COVID-19. The present study was undertaken to assess the risk and severity of COVID-19 in a US Department of Veterans Affairs (VA) cohort of patients with RA and those without RA. Methods A matched cohort study using national VA data was conducted. Patients diagnosed as having RA were identified among nondeceased individuals who were active in the VA health care system as of January 1, 2020 and who had received care in a VA medical center in 2019; patients for whom no RA diagnostic code was indicated were matched to the RA patients (1:1) by age, sex, and VA site (non-RA controls). Patients diagnosed as having COVID-19 and those with severe COVID-19 (defined as requiring hospitalization or leading to death) were ascertained from a national VA COVID-19 surveillance database through December 10, 2020. Multivariable Cox models were used to compare the risk of COVID-19 and COVID-19 hospitalization or death between RA patients and non-RA controls, after adjusting for demographic characteristics, comorbidities, health care utilization and access, and county-level COVID-19 incidence rates. Results This VA cohort of RA patients and non-RA controls (n = 33,886 subjects per group) predominantly comprised male patients (84.5%), and the mean age was 67.8 years. During follow-up, 1,503 patients in the cohort were diagnosed as having COVID-19; among them, 388 patients had severe COVID-19 (hospitalization or death), while in 228 patients, the deaths were not related to COVID-19. In the multivariable model, RA was associated with a higher risk of COVID-19 (adjusted hazard ratio [HR] 1.25 [95% confidence interval (95% CI) 1.13-1.39]) and a higher risk of COVID-19 hospitalization or death (adjusted HR 1.35 [95% CI 1.10-1.66]) as compared to non-RA controls. Use of disease-modifying antirheumatic drugs and prednisone, as well as self-reported Black race, self-reported Hispanic ethnicity, and presence of several chronic conditions, but not seropositivity for RA autoantibodies, were each associated with risk of COVID-19 and severe COVID-19 (hospitalization or death). Conclusion Patients with RA are at higher risk of developing COVID-19 and severe COVID-19 (leading to hospitalization or death) compared to those without RA. With a risk of COVID-19 that approaches that of other recognized chronic conditions, these findings suggest that RA patients should be prioritized for COVID-19 prevention and management strategies.