Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases

Kathryn C. Fitzgerald; Christopher A. Mecoli; Morgan Douglas; Samantha Harris; Berna Aravidis; Jemima Albayda; Elias S. Sotirchos; Ahmet Hoke; Ana Maria Orbai; Michelle Petri; Lisa Christopher-Stine; Alan N. Baer; Julie J. Paik; Brittany L. Adler; Eleni Tiniakou; Homa Timlin; Pavan Bhargava; Scott D. Newsome; Arun Venkatesan; Vinay Chaudhry; Thomas E. Lloyd; Carlos A. Pardo; Barney J. Stern; Mark Lazarev; Brindusa Truta; Shiv Saidha; Edward S. Chen; Michelle Sharp; Nisha Gilotra; Edward K. Kasper; Allan C. Gelber; Clifton O. Bingham; Ami A. Shah; Ellen M. Mowry

doi:10.1093/cid/ciab407

Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases

Kathryn C. Fitzgerald, Christopher A. Mecoli, Morgan Douglas, Samantha Harris, Berna Aravidis, Jemima Albayda, Elias S. Sotirchos, Ahmet Hoke, Ana Maria Orbai, Michelle Petri, Lisa Christopher-Stine, Alan N. Baer, Julie J. Paik, Brittany L. Adler, Eleni Tiniakou, Homa Timlin, Pavan Bhargava, Scott D. Newsome, Arun Venkatesan, Vinay ChaudhryThomas E. Lloyd, Carlos A. Pardo, Barney J. Stern, Mark Lazarev, Brindusa Truta, Shiv Saidha, Edward S. Chen, Michelle Sharp, Nisha Gilotra, Edward K. Kasper, Allan C. Gelber, Clifton O. Bingham, Ami A. Shah, Ellen M. Mowry

School of Medicine

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Pages (from-to)	427-436
Number of pages	10
Journal	Clinical Infectious Diseases
Volume	74
Issue number	3
DOIs	https://doi.org/10.1093/cid/ciab407
State	Published - Feb 1 2022

Keywords

COVID-19
autoimmune disease
glucocorticoids
immune-modulating medications

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

Access to Document

10.1093/cid/ciab407

Cite this

@article{79fd067667984a709e4a34c1e4761a23,

title = "Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases",

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.",

keywords = "COVID-19, autoimmune disease, glucocorticoids, immune-modulating medications",

author = "Fitzgerald, {Kathryn C.} and Mecoli, {Christopher A.} and Morgan Douglas and Samantha Harris and Berna Aravidis and Jemima Albayda and Sotirchos, {Elias S.} and Ahmet Hoke and Orbai, {Ana Maria} and Michelle Petri and Lisa Christopher-Stine and Baer, {Alan N.} and Paik, {Julie J.} and Adler, {Brittany L.} and Eleni Tiniakou and Homa Timlin and Pavan Bhargava and Newsome, {Scott D.} and Arun Venkatesan and Vinay Chaudhry and Lloyd, {Thomas E.} and Pardo, {Carlos A.} and Stern, {Barney J.} and Mark Lazarev and Brindusa Truta and Shiv Saidha and Chen, {Edward S.} and Michelle Sharp and Nisha Gilotra and Kasper, {Edward K.} and Gelber, {Allan C.} and Bingham, {Clifton O.} and Shah, {Ami A.} and Mowry, {Ellen M.}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s).",

year = "2022",

month = feb,

day = "1",

doi = "10.1093/cid/ciab407",

language = "English (US)",

volume = "74",

pages = "427--436",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "3",

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TY - JOUR

T1 - Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases

AU - Fitzgerald, Kathryn C.

AU - Mecoli, Christopher A.

AU - Douglas, Morgan

AU - Harris, Samantha

AU - Aravidis, Berna

AU - Albayda, Jemima

AU - Sotirchos, Elias S.

AU - Hoke, Ahmet

AU - Orbai, Ana Maria

AU - Petri, Michelle

AU - Christopher-Stine, Lisa

AU - Baer, Alan N.

AU - Paik, Julie J.

AU - Adler, Brittany L.

AU - Tiniakou, Eleni

AU - Timlin, Homa

AU - Bhargava, Pavan

AU - Newsome, Scott D.

AU - Venkatesan, Arun

AU - Chaudhry, Vinay

AU - Lloyd, Thomas E.

AU - Pardo, Carlos A.

AU - Stern, Barney J.

AU - Lazarev, Mark

AU - Truta, Brindusa

AU - Saidha, Shiv

AU - Chen, Edward S.

AU - Sharp, Michelle

AU - Gilotra, Nisha

AU - Kasper, Edward K.

AU - Gelber, Allan C.

AU - Bingham, Clifton O.

AU - Shah, Ami A.

AU - Mowry, Ellen M.

PY - 2022/2/1

Y1 - 2022/2/1

N2 - 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.

AB - 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.

KW - COVID-19

KW - autoimmune disease

KW - glucocorticoids

KW - immune-modulating medications

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UR - http://www.scopus.com/inward/citedby.url?scp=85124577298&partnerID=8YFLogxK

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DO - 10.1093/cid/ciab407

M3 - Article

C2 - 33956972

AN - SCOPUS:85124577298

SN - 1058-4838

VL - 74

SP - 427

EP - 436

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 3

ER -

Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases

Abstract

Keywords

ASJC Scopus subject areas

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