ABSTRACT
BackgroundEducation and employment established in young adulthood predict future lifetime socioeconomic achievements. Young adults with Systemic Lupus Erythematosus (SLE) have physical, cognitive and mental health issues and other comorbidities that may impact employment.ObjectivesTo understand the lived experiences of young adults with SLE (YASLE), as students, and to assess their perceived barriers from SLE.MethodsYASLE were recruited from two Lupus clinics in Toronto and Winnipeg. Semi-structured qualitative interviews were conducted individually via secure video conferencing. As this study was conducted during the coronavirus pandemic, participants were also asked about the pandemic impacts on their education experiences. All interviews were transcribed verbatim, double-coded and analysed using a reflexive thematic approach.ResultsTwelve participants (2 males), 9 of childhood- and 3 adult-onset SLE (cSLE, aSLE) were interviewed. Nine participants (82%) were <25 years old. Five also worked while studying. Five were Asians, 5 were White, 2 of other ethnicities. Half have severe disease (central nervous system or renal involvement). Median duration of disease was 4.0 (25th-75th percentile, 1.8- 5.3) years. The impacts of SLE on their education experience emerged in 5 themes:1) Challenges imposed by SLE: Difficulties adjusting to the diagnosis, physical and cognitive symptoms of SLE. While most participants disclosed their diagnosis to their schools, some expressed hesitation.2) Changes in aspirations: Education/career goals were modified by reducing course load or shifting to more sedentary or less cognitively demanding careers.3) Coping and acceptance: More adaptive than maladaptive coping strategies were used to manage their SLE, including self-acceptance, pacing, planning and avoidance. All strived to do well in their studies despite SLE and were hopeful for their futures.4) Facilitating factors for education success: Family and friends' social support, individualized accommodations from school and parental financial support were identified.5) Pandemic impacts: Virtual learning and flexible schedules enabled participants to adapt their schedules according to their physical conditions (e.g. pain, fatigue). However, fewer opportunities to interact in-person were viewed as challenges. Participants want hybrid options to continue even after the pandemic.ConclusionSLE affected students' performance through physical symptoms, fatigue and cognitive dysfunction. Ongoing social and school supports help to support them. Maintaining the remote learning options may increase accessibility for them. These results identified opportunities for developing future supportive interventions for YASLE patients in their schooling which then better prepare them for future employment.References[1]Jetha A, Badley E, Beaton D, Fortin PR, Shiff NJ, Gignac MA. Unpacking early work experiences of young adults with rheumatic disease: an examination of absenteeism, job disruptions, and productivity loss. Arthritis care & research. 2015;67:1246-54.[2]E. F Lawson, A. O. Hersh, L. Trupin, E. von Scheven, M. J. Okumura, J. Yazdany, et al. Educational and vocational outcomes of adults with childhood and adult onset systemic lupus erythematosus: nine years of follow-up. Arthritis Care Res 2014;66: 717-24.Acknowledgements:NIL.Disclosure of InterestsMike Golding: None declared, Fareha Nishat: None declared, Kaitlyn Merrill: None declared, Ramandeep Kaur: None declared, Jennifer Stinson: None declared, Jennifer Protudjer Speakers bureau: Nutricia (Food allergy university, Nov 2022), Consultant of: Novartis 2021, allergy products, Roberta Woodgate: None declared, Christine Peschken: None declared, Diane Lacaille: None declared, Umut Oguzoglo: None declared, Zahi Touma: None declared, Lily Lim Speakers bureau: Pfizer Feb 2023. Not drug related and not related to this .
ABSTRACT
Background: Individuals with autoimmune rheumatic diseases (ARDs) may be at greater risk of severe COVID-19 outcomes than individuals in the general population. Objectives: This study assesses the risk of COVID-19-related hospitali-zation, intensive care unit (ICU) admission, and COVID-19-specific mortality in patients with ARDs compared to matched general population comparators. Methods: We conducted a population-based cohort study, using administrative datasets from British Columbia, Canada (February 2020-August 2021). Among all test-positive SARS-CoV-2 adults, we used ICD codes to identify all individuals with an ARD: rheumatoid arthritis (RA), psoriasis/psoriatic arthritis (PsO/PsA), ankylosing spondylitis (AS), and systemic autoimmune rheumatic diseases (SARDs), including systemic lupus erythematosus (SLE), Sjogren's syndrome, systemic sclerosis, myositis, and adult systemic vas-culitides. Individuals with an ARD were matched 1:5 to general population test-positive SARS-CoV-2 individuals on age (± 5 years), sex, month/year of initial positive SARS-CoV-2 test, and health authority. Conditional logistic regression models adjusting for socioeconomic status, Charlson comorbidity index, hypertension, rural address, and number of previous COVID-19 PCR tests were performed to assess risk of COVID-19-related hospitalizations, ICU admissions, and COVID-19-specifc mortality (mortality with primary ICD code for COVID-19). Results: The risk of COVID-19-related hospitalization was signifcantly increased for patients with ARDs overall (aOR: 1.30) (Table 1). Within ARDs, the patient group at greatest risk of hospitalization was adult systemic vasculitides (aOR: 2.18). The risk of ICU admission was signifcantly increased for patients with ARDs overall (aOR: 1.30). Within ARDs, the patient group at greatest risk of ICU admission was those with AS (aOR: 2.03). The risk of COVID-19-specifc mortality was signifcantly increased for patients with ARDs overall (aOR: 1.24). Within ARDs, the patient group at greatest risk of COVID-19-specifc mortality was those with AS (aOR: 2.15). Conclusion: The risk of severe COVID-19 outcomes is increased in some ARDs, although magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis, and early intervention with available therapies (e.g., oral antivirals) should be prioritized in these groups according to risk.