September 22, 2022
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This study was funded by the American College of Rheumatology and the European Alliance of Associations for Rheumatology. Izadi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Regional socioeconomic conditions, air pollution, population mobility and the availability of health resources are all factors that impact the risk of death attributed to COVID-19 in patients with rheumatic diseases, according to data.
“We had observed significant variation in COVID-19 outcomes across countries and regions,” Zara Izadi, PhD, of the division of rheumatology at the University of California, San Francisco, told Healio. “We know there are differences in how people are treated for rheumatic diseases globally, and individual-level clinical risk factors such as comorbidities vary by region.
“However, it was evident that these clinical factors did not fully account for regional variations in COVID-19 outcomes,” Izadi added. “We had guessed that societal COVID-19 policies impacted people with rheumatic disease, but this impact had not been previously quantified.”
To examine the relationship between environmental and societal factors and country-level differences in COVID-19 deaths among patients with rheumatic disease, Izadi and colleagues conducted an observational study using data from the COVID-19 Global Rheumatology Alliance registry. Data were collected between March 12, 2020, and Aug. 27, 2021. Data from adult patients with rheumatic diseases who were confirmed positive for COVID-19 were entered by rheumatologists through online portals.
Information for each patient included demographics, disease characteristics, prescribed immunomodulatory medications for rheumatic diseases, comorbidities, COVID-19 outcomes and complications. The data also included patients’ highest level of disease severity, which ranged from “death” to “symptoms resolved at the time of data entry,” as well as individual-level demographics and characteristics relating to rheumatic disease and comorbidities. The authors included adults aged 18 to 99 years who originated in any country that contributed at least 100 cases to the registry.
The researchers generated an index date for each included country, which was defined as the first date a COVID-19 diagnosis was reported to the COVID-19 Data Repository by the Center for Systems Science and Engineering at Johns Hopkins University. Follow-up concluded on Aug. 27, 2021, or the most recent date of a diagnosis to the registry, depending on which was earlier. The study’s primary endpoint was mortality attributed to COVID-19, as certified by the reporting physician.
In total, the analysis included 14,044 patients from 23 countries. Air pollution (OR = 1.1 per 10 g/m3; 95% CI, 1.01-1.17), proportion of population aged 65 years or older (OR = 1.19 per 1% increase; 95% CI, 1.1-1.3) and mobility of the population (OR = 1.03 per 1% increase in number of visits to grocery stores and pharmacies; 95% CI, 1.02-1.05; and 1.02 per 1% increase in number of visits to workplaces; 95% CI, 1-1.03) were all independently associated with higher risks for mortality, the authors wrote. Factors associated with lower odds of mortality included number of hospital beds, human development index scores, government response stringency and follow-up time.
“The study shows that people with rheumatic disease and COVID-19 have worse outcomes if they live in societies with fewer COVID-19 containment measures,” Izadi said. “We found that clinical risk factors, including background meds, disease activity and comorbidities explained up to 30% of the observed country-level variations in COVID-19-related death. The remaining variation stemmed from temporal, environmental and societal factors such as population mobility and government containment measures. The multilayer methodological framework exemplified by this study has broad implications beyond COVID-19 and will be key to addressing other pressing global issues, such as climate change.”