TY - JOUR
T1 - Risk of COVID-19 in Rheumatoid Arthritis
T2 - A National Veterans Affairs Matched Cohort Study in At-Risk Individuals
AU - England, Bryant R
AU - Roul, Punyasha
AU - Yang, Yangyuna
AU - Kalil, Andre C
AU - Michaud, Kaleb
AU - Thiele, Geoffrey M
AU - Sauer, Brian C
AU - Baker, Joshua F
AU - Mikuls, Ted R
N1 - This article is protected by copyright. All rights reserved.
PY - 2021/5/5
Y1 - 2021/5/5
N2 - BACKGROUND: While rheumatoid arthritis (RA) and its treatments are associated with an increased infection risk, it remains unclear whether these factors impact the risk or severity of COVID-19.METHODS: We conducted a matched cohort study using national Veterans Affairs data. Among non-deceased individuals on January 1, 2020 who received VA care in 2019, we matched RA to non-RA patients (1:1) on age, sex, and VA site. COVID-19 and severe COVID-19 (hospitalization or death) were obtained from a national VA COVID-19 surveillance database through December 10, 2020. We used multivariable Cox models to compare the risk of COVID-19 and COVID-19 hospitalization or death after adjusting for demographics, comorbidities, health behaviors, and county level COVID-19 incidence rates.RESULTS: RA and non-RA patients (n=33,886 each) were male predominant (84.5%) and had a mean age of 67.8 years. During follow-up, there were 1,503 COVID-19 diagnoses, 388 severe COVID-19 cases, and 228 non-COVID-19 related deaths. After multivariable adjustment, RA was associated with a higher risk of COVID-19 (hazard ratio [HR] 1.25 [95% confidence interval 1.13, 1.39]) and COVID-19 hospitalization or death (HR 1.35 [1.10, 1.66]). DMARDs and prednisone, but not RA autoantibody seropositivity, as well as black race, Hispanic ethnicity, and several chronic conditions were associated with COVID-19 and COVID-19 hospitalization or death.CONCLUSIONS: Patients with RA are at higher risk for COVID-19 and COVID-19 hospitalization or death than non-RA. With a COVID-19 risk that approaches other recognized chronic conditions, these findings suggest RA patients should be prioritized for COVID-19 prevention and management.
AB - BACKGROUND: While rheumatoid arthritis (RA) and its treatments are associated with an increased infection risk, it remains unclear whether these factors impact the risk or severity of COVID-19.METHODS: We conducted a matched cohort study using national Veterans Affairs data. Among non-deceased individuals on January 1, 2020 who received VA care in 2019, we matched RA to non-RA patients (1:1) on age, sex, and VA site. COVID-19 and severe COVID-19 (hospitalization or death) were obtained from a national VA COVID-19 surveillance database through December 10, 2020. We used multivariable Cox models to compare the risk of COVID-19 and COVID-19 hospitalization or death after adjusting for demographics, comorbidities, health behaviors, and county level COVID-19 incidence rates.RESULTS: RA and non-RA patients (n=33,886 each) were male predominant (84.5%) and had a mean age of 67.8 years. During follow-up, there were 1,503 COVID-19 diagnoses, 388 severe COVID-19 cases, and 228 non-COVID-19 related deaths. After multivariable adjustment, RA was associated with a higher risk of COVID-19 (hazard ratio [HR] 1.25 [95% confidence interval 1.13, 1.39]) and COVID-19 hospitalization or death (HR 1.35 [1.10, 1.66]). DMARDs and prednisone, but not RA autoantibody seropositivity, as well as black race, Hispanic ethnicity, and several chronic conditions were associated with COVID-19 and COVID-19 hospitalization or death.CONCLUSIONS: Patients with RA are at higher risk for COVID-19 and COVID-19 hospitalization or death than non-RA. With a COVID-19 risk that approaches other recognized chronic conditions, these findings suggest RA patients should be prioritized for COVID-19 prevention and management.
U2 - 10.1002/art.41800
DO - 10.1002/art.41800
M3 - Article
C2 - 33955209
SN - 2326-5191
JO - Arthritis & rheumatology (Hoboken, N.J.)
JF - Arthritis & rheumatology (Hoboken, N.J.)
ER -