September 22 2022
2 minutes to read
Source / Disclosures
This study was funded by the American College of Rheumatology and the European Alliance of Rheumatological Societies. Ezady has not reported any relevant financial disclosures. Please see the study for all relevant financial disclosures by other authors.
Data indicate that regional socio-economic conditions, air pollution, population mobility, and availability of health resources all influence the risk of death attributable to COVID-19 in patients with rheumatic diseases.
“We have noticed a great importance Variation in COVID-19 outcomes across countries and regions”, Zara Izadi, Ph.D., of the department of rheumatology at the University of California, San Francisco, told Helio. “We know that there are differences in how people treat rheumatic diseases globally, and individual-level clinical risk factors such as comorbidities vary by region.
“However, it was clear that these clinical factors did not fully take into account regional differences in COVID-19 outcomes,” Izadi added. “We guessed that community COVID-19 policies affected people with rheumatic diseases, but this effect has not been measured before.”
To examine the relationship between environmental and societal factors and nation-wide differences in COVID-19 mortality among rheumatic patients, Izadi and colleagues conducted an observational study using data from Global Alliance for Rheumatology COVID-19 Register. Data were collected between March 12, 2020 and August 27, 2021. Rheumatologists entered data from adult patients with rheumatic diseases who were confirmed to have COVID-19 through online portals.
Information for each patient included demographics, disease characteristics, immunomodulating drugs prescribed for rheumatic diseases, comorbidities, COVID-19 outcomes and complications. The data also included the highest level of disease severity in patients, which ranged from ‘death’ to ‘symptoms resolved at the time of data entry’, as well as individual-level demographics and characteristics related to rheumatic and comorbidities. The authors included adults between 18 and 99 years of age who grew up in any country that contributed at least 100 cases to the registry.
The researchers created an index date for each country included, which was identified as the first date a COVID-19 diagnosis was reported to the COVID-19 data repository by the Center for Systems Science and Engineering at Johns Hopkins University. Follow-up concluded on August 27, 2021, or the latest date for the log diagnosis, depending on which was earlier. The primary end point for the study was deaths attributed to COVID-19, according to the testimony of the physician in charge.
In all, the analysis included 14,044 patients from 23 countries. air pollution (OR = 1.1 per 10 g/m3; 95% CI, 1.01-1.17, proportion of the population aged 65 years or older (OR = 1.19 for each 1% increase; 95% CI, 1.1-1.3) and mobility of the population (OR = 1.03 for each 1% increase in store visits Grocery and pharmacies; 95% CI, 1.02-1.05; and 1.02 per 1% increase in visits to workplaces; 95% CI, 1-1.03) were all independently associated with a higher risk of death, the authors wrote. Factors associated with lower odds of death included the number of hospital beds, HDI scores, rigor of the government’s response, and follow-up time.
“The study shows that people with rheumatic diseases and COVID-19 have worse outcomes if they live in communities with fewer COVID-19 containment measures,” Izadi said. We found that clinical risk factors, including medical background, disease activity, and comorbidities, explained up to 30% of the observed nationwide differences in COVID-19-related mortality. The remaining variance arose from temporal, environmental, and societal factors such as population mobility and government containment measures. The multi-layered methodological framework represented by this study has broad implications beyond COVID-19 and will be key to addressing other pressing global issues, such as climate change.