Patients with rare autoimmune rheumatic disease more likely to die during COVID pandemic
The mortality risk for a 35-year-old patient with a rare autoimmune rheumatic disease during the COVID-19 pandemic is similar to that of a 55-year-old in the general population, according to UK data published in Rheumatology.
“People with rare diseases often have poorer health outcomes generally, and this is some of the first research on what impact the COVID-19 pandemic has had on people with rare diseases,” Fiona Pearce, BMedSci, MBBS, PhD, of the University of Nottingham Division of Epidemiology and Public Health, told Healio Rheumatology.
To examine mortality risk in patients with rare autoimmune rheumatic diseases (RAIRD) throughout the COVID-19 pandemic in the United Kingdom, both compared with those without RAIRD and to their pre-pandemic risk, Peach and colleagues conducted a cohort study using Hospital Episode Statistics (HES) for England and linked data from the UK’s National Health Service.
According to the researchers, HES contains every episode of admitted NHS patient care in England — including in-patient and day-case — with all prevalent diagnoses coded according to ICD-10. Each rare autoimmune rheumatic disease maps to a unique ICD-10 code and excludes other conditions, and patients with these conditions have frequent in-patient or day-case activity, they wrote.
Focusing on patients with diagnostic codes for a rare autoimmune rheumatic disease in in-patient HES from 2003 onwards, the researchers identified 168,691 individuals who resided in England and were alive on March 1 for study inclusion. Diagnoses included systemic lupus erythematosus, scleroderma, idiopathic inflammatory myositis, Behcet’s disease, giant cell arteritis, juvenile idiopathic arthritis and varying forms of vasculitis. General population mortality rates were accessed through published data from the Office of National Statistics.
According to the researchers, 1.1% of included patients died between March and April. The age-standardized mortality rate among individuals with RAIRD was 3,669.3 per 100,000 person-years (95% CI, 3500.4-3838.1), or 1.44 times higher (95% CI, 1.42-1.45) than the average age-standardized mortality rate during the same months of the previous 5 years. Meanwhile, among the general English population, the age-standardized mortality rate was 1.38 times higher.
Age-specific mortality rates in patients with RAIRD, compared with pre-pandemic rates, were higher starting at age 35 years, while in the general population the increased risk began at 55 years. Women demonstrated a greater increase in mortality rates during the COVID-19 pandemic compared with men.
“During COVID-19, people with rare autoimmune rheumatic diseases were more likely to die than the general population,” Pearce said. “Women with rare autoimmune rheumatic diseases had a similar risk of death to men during COVID-19, whereas usually their risk of death is lower. The risk of working age people with rare autoimmune rheumatic diseases dying during COVID-19 was similar to that of someone 20 years older in the general population.”
“The next steps in our research are to look at death certificate data and find out why people have died,” she added. “We’ll be examining whether it’s due to COVID-19 infection or how much is due to the disruption to healthcare services.”