COVID-19 in patients with autoimmune diseases: characteristics and outcomes in a multinational network of cohorts across three countries

Author:

Tan Eng Hooi1,Sena Anthony G23ORCID,Prats-Uribe Albert1ORCID,You Seng Chan4,Ahmed Waheed-Ul-Rahman56,Kostka Kristin7,Reich Christian7,Duvall Scott L89,Lynch Kristine E89,Matheny Michael E1011,Duarte-Salles Talita12,Bertolin Sergio Fernandez12,Hripcsak George1314,Natarajan Karthik1314,Falconer Thomas13,Spotnitz Matthew13,Ostropolets Anna13,Blacketer Clair23,Alshammari Thamir M15,Alghoul Heba16,Alser Osaid17,Lane Jennifer C E1,Dawoud Dalia M18,Shah Karishma5,Yang Yue19,Zhang Lin2021,Areia Carlos22,Golozar Asieh2324,Recalde Martina1225,Casajust Paula26,Jonnagaddala Jitendra27ORCID,Subbian Vignesh28,Vizcaya David29,Lai Lana Y H30,Nyberg Fredrik31,Morales Daniel R32,Posada Jose D33,Shah Nigam H33,Gong Mengchun34,Vivekanantham Arani5,Abend Aaron35,Minty Evan P36,Suchard Marc37,Rijnbeek Peter3,Ryan Patrick B213,Prieto-Alhambra Daniel1

Affiliation:

1. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK

2. Janssen Research and Development, Titusville, NJ USA

3. Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands

4. Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea

5. Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, OX3, 7LD, UK

6. College of Medicine and Health, University of Exeter, St Luke’s, 2LU, USA

7. Real World Solutions, IQVIA, Cambridge, MA, USA

8. VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, UT, USA

9. Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

10. Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA

11. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA

12. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain

13. Department of Biomedical Informatics, Columbia University, New York, NY, USA

14. New York-Presbyterian Hospital, New York, NY, USA

15. Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia

16. Faculty of Medicine, Islamic University of Gaza, Palestine

17. Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA

18. Faculty of Pharmacy, Cairo University, Cairo, Egypt

19. Digital China Health Technologies Co., LTD, Beijing 100085, China

20. School of Population Medicine and Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China

21. Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3015, Australia

22. Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK

23. Regeneron Pharmaceuticals, NY, USA

24. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,, Baltimore, MD, USA

25. Universitat Autonoma de Barcelona, Bellaterra, Spain

26. Real-World Evidence, Trial Form Support, Barcelona, Spain

27. School of Public Health and Community Medicine, UNSW Sydney, Australia

28. College of Engineering, The University of Arizona Tucson, Arizona, USA

29. Bayer Pharmaceuticals, Sant Joan Despi, Barcelona, Spain

30. School of Medical Sciences, University of Manchester, UK

31. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

32. Division of Population Health Sciences, University of Dundee, Dundee, Scotland, UK

33. Stanford Center for Biomedical Informatics Research, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA

34. Health Management Institute, Southern Medical University, Guangzhou, China

35. Autoimmune Registry Inc., Guilford, CT 06437, USA

36. O’Brien School for Public Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, T2N, 1N4, Canada

37. Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA

Abstract

Abstract Objective Patients with autoimmune diseases were advised to shield to avoid coronavirus disease 2019 (COVID-19), but information on their prognosis is lacking. We characterized 30-day outcomes and mortality after hospitalization with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. Methods A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center [USA, Optum (USA), Department of Veterans Affairs (USA), Information System for Research in Primary Care-Hospitalization Linked Data (Spain) and claims data from IQVIA Open Claims (USA) and Health Insurance and Review Assessment (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalized between January and June 2020 with COVID-19, and similar patients hospitalized with influenza in 2017–18 were included. Outcomes were death and complications within 30 days of hospitalization. Results We studied 133 589 patients diagnosed and 48 418 hospitalized with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5–93.2%), chronic kidney disease (14.0–52.7%) and heart disease (29.0–83.8%) was higher in hospitalized vs diagnosed patients with COVID-19. Compared with 70 660 hospitalized with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2–4.3% vs 6.32–24.6%). Conclusion Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality.

Funder

National Heart, Lung, and Blood Institute

National Institute of Diabetes and Digestive and Kidney Diseases

National Institutes of Health

Wellcome Trust Clinical Research Development Fellowship

Health Data Research UK

National Institute of Health Research

US National Institutes of Health

IMI 2 Joint Undertaking

European Union’s Horizon 2020 research and innovation programme

Bill & Melinda Gates Foundation

Bio Industrial Strategic Technology Development Program

Ministry of Health & Welfare, Republic of Korea

NIHR Senior Research Fellowship

MRC-DTP

US National Library of Medicine

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

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