COVID-19 in patients with autoimmune diseases: characteristics and outcomes in a multinational network of cohorts across three countries

Eng Hooi Tan; Anthony G Sena; Albert Prats-Uribe; Seng Chan You; Waheed-Ul-Rahman Ahmed; Kristin Kostka; Christian Reich; Scott L Duvall; Kristine E Lynch; Michael E Matheny; Talita Duarte-Salles; Sergio Fernandez Bertolin; George Hripcsak; Karthik Natarajan; Thomas Falconer; Matthew Spotnitz; Anna Ostropolets; Clair Blacketer; Thamir M Alshammari; Heba Alghoul; Osaid Alser; Jennifer C E Lane; Dalia M Dawoud; Karishma Shah; Yue Yang; Lin Zhang; Carlos Areia; Asieh Golozar; Martina Recalde; Paula Casajust; Jitendra Jonnagaddala; Vignesh Subbian; David Vizcaya; Lana Y H Lai; Fredrik Nyberg; Daniel R Morales; Jose D Posada; Nigam H Shah; Mengchun Gong; Arani Vivekanantham; Aaron Abend; Evan P Minty; Marc Suchard; Peter Rijnbeek; Patrick B Ryan; Daniel Prieto-Alhambra

doi:10.1093/rheumatology/keab250

COVID-19 in patients with autoimmune diseases: characteristics and outcomes in a multinational network of cohorts across three countries

Rheumatology (Oxford). 2021 Oct 9;60(SI):SI37-SI50. doi: 10.1093/rheumatology/keab250.

Authors

Eng Hooi Tan¹, Anthony G Sena^{2

3}, Albert Prats-Uribe¹, Seng Chan You⁴, Waheed-Ul-Rahman Ahmed^{5

6}, Kristin Kostka⁷, Christian Reich⁷, Scott L Duvall^{8

9}, Kristine E Lynch^{8

9}, Michael E Matheny^{10

11}, Talita Duarte-Salles¹², Sergio Fernandez Bertolin¹², George Hripcsak^{13

14}, Karthik Natarajan^{13

14}, Thomas Falconer¹³, Matthew Spotnitz¹³, Anna Ostropolets¹³, Clair Blacketer^{2

3}, Thamir M Alshammari¹⁵, Heba Alghoul¹⁶, Osaid Alser¹⁷, Jennifer C E Lane¹, Dalia M Dawoud¹⁸, Karishma Shah⁵, Yue Yang¹⁹, Lin Zhang^{20

21}, Carlos Areia²², Asieh Golozar^{23

24}, Martina Recalde^{12

25}, Paula Casajust²⁶, Jitendra Jonnagaddala²⁷, Vignesh Subbian²⁸, David Vizcaya²⁹, Lana Y H Lai³⁰, Fredrik Nyberg³¹, Daniel R Morales³², Jose D Posada³³, Nigam H Shah³³, Mengchun Gong³⁴, Arani Vivekanantham⁵, Aaron Abend³⁵, Evan P Minty³⁶, Marc Suchard³⁷, Peter Rijnbeek³, Patrick B Ryan^{2

13}, Daniel Prieto-Alhambra¹

Affiliations

¹ Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK.
² Janssen Research and Development, Titusville, NJ USA.
³ Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁴ Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea.
⁵ Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, OX3, 7LD, UK.
⁶ College of Medicine and Health, University of Exeter, St Luke's, 2LU, USA.
⁷ Real World Solutions, IQVIA, Cambridge, MA, USA.
⁸ VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, UT, USA.
⁹ Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹⁰ Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA.
¹¹ Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
¹² Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
¹³ Department of Biomedical Informatics, Columbia University, New York, NY, USA.
¹⁴ New York-Presbyterian Hospital, New York, NY, USA.
¹⁵ Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia.
¹⁶ Faculty of Medicine, Islamic University of Gaza, Palestine.
¹⁷ Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA.
¹⁸ Faculty of Pharmacy, Cairo University, Cairo, Egypt.
¹⁹ Digital China Health Technologies Co., LTD, Beijing 100085, China.
²⁰ School of Population Medicine and Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China.
²¹ Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3015, Australia.
²² Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK.
²³ Regeneron Pharmaceuticals, NY, USA.
²⁴ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,, Baltimore, MD, USA.
²⁵ Universitat Autonoma de Barcelona, Bellaterra, Spain.
²⁶ Real-World Evidence, Trial Form Support, Barcelona, Spain.
²⁷ School of Public Health and Community Medicine, UNSW Sydney, Australia.
²⁸ College of Engineering, The University of Arizona Tucson, Arizona, USA.
²⁹ Bayer Pharmaceuticals, Sant Joan Despi, Barcelona, Spain.
³⁰ School of Medical Sciences, University of Manchester, UK.
³¹ School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³² Division of Population Health Sciences, University of Dundee, Dundee, Scotland, UK.
³³ Stanford Center for Biomedical Informatics Research, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
³⁴ Health Management Institute, Southern Medical University, Guangzhou, China.
³⁵ Autoimmune Registry Inc., Guilford, CT 06437, USA.
³⁶ O'Brien School for Public Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, T2N, 1N4, Canada.
³⁷ Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA.

Abstract

Objective: Patients with autoimmune diseases were advised to shield to avoid coronavirus disease 2019 (COVID-19), but information on their prognosis is lacking. We characterized 30-day outcomes and mortality after hospitalization with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza.

Methods: A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center [USA, Optum (USA), Department of Veterans Affairs (USA), Information System for Research in Primary Care-Hospitalization Linked Data (Spain) and claims data from IQVIA Open Claims (USA) and Health Insurance and Review Assessment (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalized between January and June 2020 with COVID-19, and similar patients hospitalized with influenza in 2017-18 were included. Outcomes were death and complications within 30 days of hospitalization.

Results: We studied 133 589 patients diagnosed and 48 418 hospitalized with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5-93.2%), chronic kidney disease (14.0-52.7%) and heart disease (29.0-83.8%) was higher in hospitalized vs diagnosed patients with COVID-19. Compared with 70 660 hospitalized with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2-4.3% vs 6.32-24.6%).

Conclusion: Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality.

Keywords: COVID-19; Observational Health Data Sciences and Informatics (OHDSI); Observational Medical Outcomes Partnership (OMOP); autoimmune condition; hospitalization; mortality; open science.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Aged
Aged, 80 and over
Autoimmune Diseases / mortality*
Autoimmune Diseases / virology*
COVID-19 / immunology
COVID-19 / mortality*
Cohort Studies
Female
Hospitalization / statistics & numerical data*
Humans
Influenza, Human / immunology
Influenza, Human / mortality*
Male
Middle Aged
Prevalence
Prognosis
Republic of Korea / epidemiology
SARS-CoV-2
Spain / epidemiology
United States / epidemiology
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding