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RISK FACTORS FOR INFECTION AND HEALTH IMPACTS OF THE COVID-19 PANDEMIC IN PEOPLE WITH AUTOIMMUNE DISEASES.
Fitzgerald, Kathryn C; Mecoli, Christopher A; Douglas, Morgan; Harris, Samantha; Aravidis, Berna; Albayda, Jemima; Sotirchos, Elias S; Hoke, Ahmet; Orbai, Ana-Maria; Petri, Michelle; Christopher-Stine, Lisa; Baer, Alan N; Paik, Julie J; Adler, Brittany L; Tiniakou, Eleni; Timlin, Homa; Bhargava, Pavan; Newsome, Scott D; Venkatesan, Arun; Chaudhry, Vinay; Lloyd, Thomas E; Pardo, Carlos A; Stern, Barney J; Lazarev, Mark; Truta, Brindusa; Saidha, Shiv; Chen, Edward S; Sharp, Michelle; Gilotra, Nisha; Kasper, Edward K; Gelber, Allan C; Bingham, Clifton O; Shah, Ami A; Mowry, Ellen M.
Afiliação
  • Fitzgerald KC; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Mecoli CA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Douglas M; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Harris S; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Aravidis B; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Albayda J; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Sotirchos ES; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Hoke A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Orbai AM; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Petri M; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Christopher-Stine L; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Baer AN; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Paik JJ; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Adler BL; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Tiniakou E; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Timlin H; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Bhargava P; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Newsome SD; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Venkatesan A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Chaudhry V; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Lloyd TE; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Pardo CA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Stern BJ; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Lazarev M; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Truta B; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Saidha S; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Chen ES; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Sharp M; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Gilotra N; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Kasper EK; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Gelber AC; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Bingham CO; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Shah AA; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Mowry EM; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
medRxiv ; 2021 Feb 05.
Article em En | MEDLINE | ID: mdl-33564774
ABSTRACT

Background:

People with autoimmune or inflammatory conditions who take immunomodulatory/suppressive medications may have a higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences.

Objective:

Assess whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterize pandemic-associated changes to care.

Design:

Longitudinal registry study.

Participants:

4666 individuals with autoimmune or inflammatory conditions followed by specialists in neurology, rheumatology, cardiology, pulmonology or gastroenterology at Johns Hopkins. Measurements Periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare.

Results:

A total of 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medication exposure) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in multivariable models incorporating behavior and other potential confounders (OR 1.43; 95%CI 1.08, 1.89). Other medication classes were not associated with COVID-19 risk. Diabetes (OR 1.72; 95%CI 1.08, 2.73), cardiovascular disease (OR 1.68; 95%CI 1.24, 2.28), and chronic kidney disease (OR 1.76; 95%CI 1.04, 2.97) were each associated with higher odds of COVID-19. Pandemic-related disruption to care was common. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions. Individuals experiencing changes to employment or income were at highest odds of care disruption.

Limitations:

Results may not be generalizable to all patients with autoimmune or inflammatory conditions. Information was self-reported.

Conclusions:

Exposure to glucocorticoids may increase risk of COVID-19 in people with autoimmune or inflammatory conditions. Disruption to healthcare and related services was common. Those with pandemic-related reduced income may be most vulnerable to care disruptions.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: MedRxiv Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: MedRxiv Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos