Risk of COVID-19 Among Unvaccinated and Vaccinated Patients With Rheumatoid Arthritis: A General Population Study.

OBJECTIVE: To determine whether patients with rheumatoid arthritis (RA) are at higher risks for SARS-CoV-2 infection and its severe outcomes before and after COVID-19 vaccination. METHODS: Using a UK primary care database, we conducted 2 cohort studies to compare the risks of SARS-CoV-2 infection, hospitalization, and death from COVID-19 between patients with RA and the general population according to their COVID-19 vaccination status. We used exposure score overlap weighting to balance baseline characteristics between 2 comparison cohorts. RESULTS: Among unvaccinated individuals, the weighted incidence rates of SARS-CoV-2 infection (9.21 versus 8.16 of 1,000 person-months), hospitalization (3.46 versus 2.14 of 1,000 person-months), and death (1.19 versus 0.62 of 1,000 person-months) were higher among patients with RA than the general population over 3 months of follow-up; the corresponding adjusted hazard ratios (HRs) were 1.10 (95% confidence interval [95% CI] 1.00-1.24), 1.62 (95% CI 1.34-1.96), and 1.88 (95% CI 1.37-2.60), respectively. Among vaccinated individuals, the weighted rates of breakthrough infection (4.17 versus 3.96 of 1,000 person-months; HR 1.10 [95% CI 1.00-1.20]) and hospitalization (0.42 versus 0.32 of 1,000 person-months; HR 1.29 [95% CI 0.96-1.75]) were higher among patients with RA than the general population over 9 months of follow-up; however, no apparent difference in the risk of these outcomes was observed over 3 and 6 months of follow-up between 2 comparison cohorts. CONCLUSION: Patients with RA are still at higher risks of SARS-CoV-2 infection and COVID-19 hospitalization than the general population after receiving COVID-19 vaccines. These findings support booster COVID-19 vaccinations and adherence of other preventive strategies among patients with RA.

Comparative effectiveness of BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19.

BACKGROUND: Both BNT162b2 (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines have shown high efficacy against COVID-19 in randomized controlled trials. However, their comparative effectiveness against COVID-19 is unclear in the real world. We evaluated the comparative effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19 in the UK general population. METHODS: We emulated a target trial using IQVIA Medical Research Database (IMRD), an electronic primary care database from the UK (2021). We included 1,311,075 participants, consisting of 637,549 men and 673,526 women age≥18 years, who received vaccination with BNT162b2 or ChAdOx1 nCoV-19 between January 1 and August 31, 2021. The outcomes consisted of confirmed diagnosis of SARS-CoV-2 infection, hospitalisation for COVID-19 and death from COVID-19 in the IMRD. We performed a cox-proportional hazard model to compare the risk of each outcome variable between the two vaccines adjusting for potential confounders with time-stratified overlap weighting of propensity score (PS). RESULTS: During a mean of 6.7 months of follow-up, 20,070 confirmed SARS-CoV-2 infection occurred in individuals who received BNT162b2 vaccine (PS weighted incidence rate: 3.65 per 1000 person-months), and 31,611 SARS-CoV-2 infection occurred in those who received ChAdOx1 nCoV-19 vaccine (PS weighted incidence rate: 5.25 per 1000 person-months). The time-stratified PS weighted rate difference of SARS-CoV-2 infection for BNT162b2 group vs. ChAdOx1 nCoV-19 group was -1.60 per 1000 person-months (95% confidence interval [CI]: -1.76 to -1.43 per 1000 person-months), and the hazard ratio was 0.69 (95% CI: 0.68 to 0.71). The results were similar across the stratum of sex, age (<65 and ≥65 years), and study periods (i.e., alpha-variant predominance period and delta-variant predominance period). The PS weighted incidence of hospitalisation for COVID-19 was also lower in the BNT162b2 vaccine group than that in the ChAdOx1 vaccine group (RD: -0.09, 95%CI: -0.13 to -0.05 per 1000 person-months; HR: 0.65, 95%CI: 0.57 to 0.74). No significant difference in the risk of death from COVID-19 was observed between the two comparison groups. CONCLUSIONS: In this population-based study, the BNT162b2 vaccine appears to be more efficacious than the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2 infection and hospitalisation for COVID-19 but not death from COVID-19.

Risk of COVID-19 among unvaccinated and vaccinated patients with systemic lupus erythematosus: a general population study.

OBJECTIVE: To compare the risk of SARS-CoV-2 infection and its related severe sequelae between patients with systemic lupus erythematosus (SLE) and the general population according to COVID-19 vaccination status. METHODS: We performed cohort studies using data from The Health Improvement Network to compare the risks of SARS-CoV-2 infection and severe sequelae between patients with SLE and the general population. Individuals aged 18-90 years with no previously documented SARS-CoV-2 infection were included. We estimated the incidence rates and HRs of SARS-CoV-2 infection and severe sequelae between patients with SLE and the general population according to COVID-19 vaccination status using exposure score overlap weighted Cox proportional hazards model. RESULTS: We identified 3245 patients with SLE and 1 755 034 non-SLE individuals from the unvaccinated cohort. The rates of SARS-CoV-2 infection, COVID-19 hospitalisation, COVID-19 death and combined severe outcomes per 1000 person-months were 10.95, 3.21, 1.16 and 3.86 among patients with SLE, and 8.50, 1.77, 0.53 and 2.18 among general population, respectively. The corresponding adjusted HRs were 1.28 (95% CI: 1.03 to 1.59), 1.82 (95% CI: 1.21 to 2.74), 2.16 (95% CI: 1.00 to 4.79) and 1.78 (95% CI: 1.21 to 2.61). However, no statistically significant differences were observed between vaccinated patients with SLE and vaccinated general population over 9 months of follow-up. CONCLUSION: While unvaccinated patients with SLE were at higher risk of SARS-CoV-2 infection and its severe sequelae than the general population, no such difference was observed among vaccinated population. The findings indicate that COVID-19 vaccination provides an adequate protection to most patients with SLE from COVID-19 breakthrough infection and its severe sequelae.

[Evolution and Characteristics of Full-process Vehicular VOCs Emissions in Tianjin from 2000 to 2020].

Vehicle emissions are an important source of anthropogenic volatile organic compound (VOCs) emissions in urban areas and are commonly quantified using vehicle emission inventories. However, most previous studies on vehicle emission inventories have incomplete emission factors and emission processes or insufficient consideration of meteorological parameters. Based on the localized full-process emission factors attained from tested data and previous studies, a method to develop a monthly vehicular VOC emission inventory of full process for the long-term was established, which covered exhaust and evaporative emissions (including running loss, diurnal breathing loss, hot soak loss, and refueling emission). Then, the method was used to develop a full-process vehicular VOC emission inventory in Tianjin from 2000 to 2020. The results showed that the total vehicular VOC emissions in Tianjin rose slowly and then gradually decreased. In 2020, the total emissions were 21400 tons. The light-duty passenger vehicles were the dominant contributors and covered 75.00% of the total emissions. Unlike the continuous decline in exhaust emissions, evaporative emissions showed an inverted U-shaped trend with an increasing contribution to total emissions yearly, accounting for 31.69% in 2020. Monthly emissions were affected by both vehicle activity and emission factors. VOC emissions were high in autumn and winter and low in spring and summer. During the COVID-19 epidemic in 2020, vehicle activity was limited by closure and control, making VOC emissions significantly lower than those during the same period in previous years. The method and data in this study can provide technical reference and a decision-making basis for air pollution prevention and control.

Gout and Excess Risk of Severe SARS-CoV-2 Infection Among Vaccinated Individuals: A General Population Study.

OBJECTIVE: Gout patients often have multiple comorbidities, making them susceptible to SARS-CoV-2 infection and poor outcomes. This study was undertaken to examine the association between gout and the risk of SARS-CoV-2 infection and severe outcomes, especially in patients who have received a SARS-CoV-2 vaccine. METHODS: We conducted 2 cohort studies using The Health Improvement Network in the UK. Individuals with gout and those without gout from the general population were followed up from December 8, 2020 to October 31, 2021. We estimated the rate difference (RD) and hazard ratio (HR) of SARS-CoV-2 infection and severe outcomes (i.e., hospitalization and death within 30 days after SARS-CoV-2 infection) for individuals with gout versus those without gout using a Cox proportional hazards model according to SARS-CoV-2 vaccination status. We adjusted for potential confounders by using overlap weighting of exposure scores. RESULTS: Among the vaccinated cohort, 1,955 cases of breakthrough COVID-19 infection occurred in 54,576 individuals with gout (4.68 cases per 1,000 person-months), and 52,468 cases occurred in 1,336,377 individuals without gout (3.76 cases per 1,000 person-months). The partially adjusted RD of breakthrough infection was 0.91 cases per 1,000 person-months (95% confidence interval [95% CI] 0.62-1.20 cases per 1,000 person-months), and the partially adjusted HR was 1.24 (95% CI 1.19-1.30). Gout was also associated with an increased risk of hospitalization (adjusted HR 1.30 [95% CI 1.10-1.53]) and death (adjusted HR 1.36 [95% CI 0.87-2.13]). Women with gout had an increased risk of hospitalization (adjusted HR 1.55 [95% CI 1.15-2.10]) and death (adjusted HR 2.46 [95% CI 1.12-5.41]). Similar associations with gout were observed in the unvaccinated cohort. CONCLUSION: These general population data suggest that individuals with gout, especially women, have higher risks of SARS-CoV-2 infection and severe outcomes, even when vaccinated.

Severe COVID-19 outcomes among patients with autoimmune rheumatic diseases or transplantation: a population-based matched cohort study

Objectives To assess the risk of severe COVID-19 outcomes in patients with autoimmune rheumatic diseases (ARDs) and transplant recipients compared with matched general population comparators. Design Population-based matched cohort study using administrative health data sets. Setting British Columbia, Canada. Participants All adults with test-positive SARS-CoV-2 infections. SARS-CoV-2-positive patients with ARDs and those with transplantation were matched to SARS-CoV-2-positive general population comparators on age (±5 years), sex, month/year of initial positive SARS-CoV-2 test and health authority. Outcome measures COVID-19-related hospitalisations, intensive care unit (ICU) admissions, invasive ventilation and COVID-19-specific mortality. We performed multivariable conditional logistic regression models adjusting for socioeconomic status, Charlson Comorbidity Index, hypertension, rural address and number of previous COVID-19 PCR tests. Results Among 6279 patients with ARDs and 222 transplant recipients, all SARS-CoV-2 test positive, risk of hospitalisation was significantly increased among patients with ARDs (overall ARDs (adjusted OR (aOR) 1.30;95% CI 1.19 to 1.43));highest within ARDs: adult systemic vasculitides (aOR 2.18;95% CI 1.17 to 4.05) and transplantation (aOR 10.56;95% CI 6.88 to 16.22). Odds of ICU admission were significantly increased among patients with ARDs (overall ARDs (aOR 1.30;95% CI 1.11 to 1.51));highest within ARDs: ankylosing spondylitis (aOR 2.03;95% CI 1.18 to 3.50) and transplantation (aOR 8.13;95% CI 4.76 to 13.91). Odds of invasive ventilation were significantly increased among patients with ARDs (overall ARDs (aOR 1.60;95% CI 1.27 to 2.01));highest within ARDs: ankylosing spondylitis (aOR 2.63;95% CI 1.14 to 6.06) and transplantation (aOR 8.64;95% CI 3.81 to 19.61). Risk of COVID-19-specific mortality was increased among patients with ARDs (overall ARDs (aOR 1.24;95% CI 1.05 to 1.47));highest within ARDs: ankylosing spondylitis (aOR 2.15;95% CI 1.02 to 4.55) and transplantation (aOR 5.48;95% CI 2.82 to 10.63). Conclusions The risk of severe COVID-19 outcomes is increased in certain patient groups with ARDs or transplantation, although the magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis and early intervention with available therapies, should be prioritised in these groups according to risk.

Immunosuppression and COVID-19 infection in British Columbia: Protocol for a linkage study of population-based administrative and self-reported survey data.

INTRODUCTION: Cases of the novel coronavirus disease (COVID-19) continue to spread around the world even one year after the declaration of a global pandemic. Those with weakened immune systems, due to immunosuppressive medications or disease, may be at higher risk of COVID-19. This includes individuals with autoimmune diseases, cancer, transplants, and dialysis patients. Assessing the risk and outcomes of COVID-19 in this population has been challenging. While administrative databases provide data with minimal selection and recall bias, clinical and behavioral data is lacking. To address this, we are collecting self-reported survey data from a randomly selected subsample with and without COVID-19, which will be linked to administrative health data, to better quantify the risk of COVID-19 infection associated with immunosuppression. METHODS AND ANALYSIS: Using administrative and laboratory data from British Columbia (BC), Canada, we established a population-based case-control study of all individuals who tested positive for SARS-CoV-2. Each case was matched to 40 randomly selected individuals from two control groups: individuals who tested negative for SARS-CoV-2 (i.e., negative controls) and untested individuals from the general population (i.e., untested controls). We will contact 1000 individuals from each group to complete a survey co-designed with patient partners. A conditional logistic regression model will adjust for potential confounders and effect modifiers. We will examine the odds of COVID-19 infection according to immunosuppressive medication or disease type. To adjust for relevant confounders and effect modifiers not available in administrative data, the survey will include questions on behavioural variables that influence probability of being tested, acquiring COVID-19, and experiencing severe outcomes. ETHICS AND DISSEMINATION: This study has received approval from the University of British Columbia Clinical Research Ethics Board [H20-01914]. Findings will be disseminated through scientific conferences, open access peer-reviewed journals, COVID-19 research repositories and dissemination channels used by our patient partners.

Risk factors related to the severity of COVID-19 in Wuhan.

Objective: To evaluate the characteristics at admission of patients with moderate COVID-19 in Wuhan and to explore risk factors associated with the severe prognosis of the disease for prognostic prediction. Methods: In this retrospective study, moderate and severe disease was defined according to the report of the WHO-China Joint Mission on COVID-19. Clinical characteristics and laboratory findings of 172 patients with laboratory-confirmed moderate COVID-19 were collected when they were admitted to the Cancer Center of Wuhan Union Hospital between February 13, 2020 and February 25, 2020. This cohort was followed to March 14, 2020. The outcomes, being discharged as mild cases or developing into severe cases, were categorized into two groups. The data were compared and analyzed with univariate logistic regression to identify the features that differed significantly between the two groups. Based on machine learning algorithms, a further feature selection procedure was performed to identify the features that can contribute the most to the prediction of disease severity. Results: Of the 172 patients, 112 were discharged as mild cases, and 60 developed into severe cases. Four clinical characteristics and 18 laboratory findings showed significant differences between the two groups in the statistical test (P<0.01) and univariate logistic regression analysis (P<0.01). In the further feature selection procedure, six features were chosen to obtain the best performance in discriminating the two groups with a linear kernel support vector machine. The mean accuracy was 91.38%, with a sensitivity of 0.90 and a specificity of 0.94. The six features included interleukin-6, high-sensitivity cardiac troponin I, procalcitonin, high-sensitivity C-reactive protein, chest distress and calcium level. Conclusions: With the data collected at admission, the combination of one clinical characteristic and five laboratory findings contributed the most to the discrimination between the two groups with a linear kernel support vector machine classifier. These factors may be risk factors that can be used to perform a prognostic prediction regarding the severity of the disease for patients with moderate COVID-19 in the early stage of the disease.