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Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (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.
  • Fitzgerald KC; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Mecoli CA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Douglas M; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Harris S; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Aravidis B; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Albayda J; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Sotirchos ES; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Hoke A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Orbai AM; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Petri M; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Christopher-Stine L; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Baer AN; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Paik JJ; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Adler BL; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Tiniakou E; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Timlin H; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Bhargava P; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Newsome SD; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Venkatesan A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Chaudhry V; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Lloyd TE; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Pardo CA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Stern BJ; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Lazarev M; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Truta B; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Saidha S; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Chen ES; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Sharp M; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Gilotra N; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Kasper EK; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Gelber AC; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Bingham CO; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  • Shah AA; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
  • Mowry EM; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis ; 74(3): 427-436, 2022 02 11.
Article in English | MEDLINE | ID: covidwho-1684536
ABSTRACT

BACKGROUND:

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

METHODS:

We included participants with autoimmune or inflammatory conditions followed by specialists at Johns Hopkins. Participants completed periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. We assessed whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterized pandemic-associated changes to care and mental health.

RESULTS:

In total, 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medications) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in models incorporating behavior and other potential confounders (odds ratio [OR] 1.43; 95% confidence interval [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 kidney disease (OR 1.76; 95% CI 1.04, 2.97) were associated with higher odds of COVID-19. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions therein, which disproportionately affected individuals experiencing changes to employment or income.

CONCLUSIONS:

Glucocorticoid exposure 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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Autoimmune Diseases / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Autoimmune Diseases / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid