Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality

Cooksey, Roxanne; Underwood, Jonathan; Brophy, Sinead; Atkinson, Mark; Kennedy, Jonathan; Choy, Ernest

doi:10.1093/rheumatology/keac283

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Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality

Roxanne Cooksey

, Jonathan Underwood, Sinead Brophy

, Mark Atkinson

, Jonathan Kennedy, Ernest Choy

Rheumatology, Volume: 61, Issue: SI2, Pages: SI120 - SI128

Swansea University Authors: Roxanne Cooksey , Sinead Brophy , Mark Atkinson , Jonathan Kennedy

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DOI (Published version): 10.1093/rheumatology/keac283

Abstract

ObjectivesInvestigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK.MethodsRetrospective, population-based cohort study using linked, anonymized electronic health da...

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Published in:	Rheumatology
ISSN:	1462-0324 1462-0332
Published:	Oxford University Press (OUP) 2022
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Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases.ResultsA total of 1966 people with IA and 166 602 without tested positive for COVID-19. The incidence rate was 3.5% (1966/56 914) in IA, vs 6% in the general population (166 602/2 760 442), (difference: 2.5%, 95% CI: 2.4%, 2.7%, P ≤0.001). In an adjusted Cox proportional hazard model, IA was not associated with higher mortality (HR: 0.56, 95% CI: 0.18, 1.64, P=0.286). Significant risk factors included shielding (HR: 1.52, 95% CI: 1.40, 1.64, P ≤0.001), hospitalization for previous infections (HR: 1.20, 95% CI: 1.12, 1.28, P ≤0.001), hospitalizations one year pre-pandemic (HR: 1.34, 95% CI: 1.25, 1.44, P ≤0.001) and glucocorticoid use (HR: 1.17, 95% CI: 1.09, 1.25, P ≤0.001).ConclusionsIndividuals with IA had a lower incidence of COVID-19, probably due to shielding. IA was not associated with increased mortality following COVID-19 infection; being vulnerable (shielded), comorbidities and other factors were associated with increased risk. These key risk factors can identify individuals with IA at greater risk from COVID-19 and advised to shield during high community prevalence.</abstract><type>Journal Article</type><journal>Rheumatology</journal><volume>61</volume><journalNumber>SI2</journalNumber><paginationStart>SI120</paginationStart><paginationEnd>SI128</paginationEnd><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1462-0324</issnPrint><issnElectronic>1462-0332</issnElectronic><keywords>inflammatory arthritis, RA, PsA, AS, COVID-19, electronic health records</keywords><publishedDay>28</publishedDay><publishedMonth>6</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-06-28</publishedDate><doi>10.1093/rheumatology/keac283</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders/><projectreference/><lastEdited>2023-01-19T09:55:45.5360194</lastEdited><Created>2023-01-19T09:44:19.8891594</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Roxanne</firstname><surname>Cooksey</surname><orcid>0000-0002-6763-9373</orcid><order>1</order></author><author><firstname>Jonathan</firstname><surname>Underwood</surname><order>2</order></author><author><firstname>Sinead</firstname><surname>Brophy</surname><orcid>0000-0001-7417-2858</orcid><order>3</order></author><author><firstname>Mark</firstname><surname>Atkinson</surname><orcid>0000-0003-4237-3588</orcid><order>4</order></author><author><firstname>Jonathan</firstname><surname>Kennedy</surname><orcid/><order>5</order></author><author><firstname>Ernest</firstname><surname>Choy</surname><orcid>0000-0003-4459-8609</orcid><order>6</order></author></authors><documents><document><filename>62372__26337__5539f4f995224d80a2156218d11a03cb.pdf</filename><originalFilename>62372.pdf</originalFilename><uploaded>2023-01-19T09:49:05.5962556</uploaded><type>Output</type><contentLength>257682</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright: The Author(s) 2022. 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spelling	2023-01-19T09:55:45.5360194 v2 62372 2023-01-19 Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality df63826249b712dcb03cb0161d0f3daf 0000-0002-6763-9373 Roxanne Cooksey Roxanne Cooksey true false 84f5661b35a729f55047f9e793d8798b 0000-0001-7417-2858 Sinead Brophy Sinead Brophy true false 8f85ae301cc97a48eaf58fe343c5a797 0000-0003-4237-3588 Mark Atkinson Mark Atkinson true false 08163d1f58d7fefcb1c695bcc2e0ef68 Jonathan Kennedy Jonathan Kennedy true false 2023-01-19 HDAT ObjectivesInvestigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK.MethodsRetrospective, population-based cohort study using linked, anonymized electronic health data from SAIL Databank, including primary/secondary care, rheumatology, Office for National Statistics Mortality and COVID-19 laboratory data. Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases.ResultsA total of 1966 people with IA and 166 602 without tested positive for COVID-19. The incidence rate was 3.5% (1966/56 914) in IA, vs 6% in the general population (166 602/2 760 442), (difference: 2.5%, 95% CI: 2.4%, 2.7%, P ≤0.001). In an adjusted Cox proportional hazard model, IA was not associated with higher mortality (HR: 0.56, 95% CI: 0.18, 1.64, P=0.286). Significant risk factors included shielding (HR: 1.52, 95% CI: 1.40, 1.64, P ≤0.001), hospitalization for previous infections (HR: 1.20, 95% CI: 1.12, 1.28, P ≤0.001), hospitalizations one year pre-pandemic (HR: 1.34, 95% CI: 1.25, 1.44, P ≤0.001) and glucocorticoid use (HR: 1.17, 95% CI: 1.09, 1.25, P ≤0.001).ConclusionsIndividuals with IA had a lower incidence of COVID-19, probably due to shielding. IA was not associated with increased mortality following COVID-19 infection; being vulnerable (shielded), comorbidities and other factors were associated with increased risk. These key risk factors can identify individuals with IA at greater risk from COVID-19 and advised to shield during high community prevalence. Journal Article Rheumatology 61 SI2 SI120 SI128 Oxford University Press (OUP) 1462-0324 1462-0332 inflammatory arthritis, RA, PsA, AS, COVID-19, electronic health records 28 6 2022 2022-06-28 10.1093/rheumatology/keac283 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University SU Library paid the OA fee (TA Institutional Deal) 2023-01-19T09:55:45.5360194 2023-01-19T09:44:19.8891594 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Roxanne Cooksey 0000-0002-6763-9373 1 Jonathan Underwood 2 Sinead Brophy 0000-0001-7417-2858 3 Mark Atkinson 0000-0003-4237-3588 4 Jonathan Kennedy 5 Ernest Choy 0000-0003-4459-8609 6 62372__26337__5539f4f995224d80a2156218d11a03cb.pdf 62372.pdf 2023-01-19T09:49:05.5962556 Output 257682 application/pdf Version of Record true Copyright: The Author(s) 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License true eng https://creativecommons.org/licenses/by-nc/4.0/
title	Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality
spellingShingle	Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality Roxanne Cooksey Sinead Brophy Mark Atkinson Jonathan Kennedy
title_short	Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality
title_full	Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality
title_fullStr	Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality
title_full_unstemmed	Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality
title_sort	Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality
author_id_str_mv	df63826249b712dcb03cb0161d0f3daf 84f5661b35a729f55047f9e793d8798b 8f85ae301cc97a48eaf58fe343c5a797 08163d1f58d7fefcb1c695bcc2e0ef68
author_id_fullname_str_mv	df63826249b712dcb03cb0161d0f3daf_*_Roxanne Cooksey 84f5661b35a729f55047f9e793d8798b__Sinead Brophy 8f85ae301cc97a48eaf58fe343c5a797__Mark Atkinson 08163d1f58d7fefcb1c695bcc2e0ef68_*_Jonathan Kennedy
author	Roxanne Cooksey Sinead Brophy Mark Atkinson Jonathan Kennedy
author2	Roxanne Cooksey Jonathan Underwood Sinead Brophy Mark Atkinson Jonathan Kennedy Ernest Choy
format	Journal article
container_title	Rheumatology
container_volume	61
container_issue	SI2
container_start_page	SI120
publishDate	2022
institution	Swansea University
issn	1462-0324 1462-0332
doi_str_mv	10.1093/rheumatology/keac283
publisher	Oxford University Press (OUP)
college_str	Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str	1
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description	ObjectivesInvestigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK.MethodsRetrospective, population-based cohort study using linked, anonymized electronic health data from SAIL Databank, including primary/secondary care, rheumatology, Office for National Statistics Mortality and COVID-19 laboratory data. Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases.ResultsA total of 1966 people with IA and 166 602 without tested positive for COVID-19. The incidence rate was 3.5% (1966/56 914) in IA, vs 6% in the general population (166 602/2 760 442), (difference: 2.5%, 95% CI: 2.4%, 2.7%, P ≤0.001). In an adjusted Cox proportional hazard model, IA was not associated with higher mortality (HR: 0.56, 95% CI: 0.18, 1.64, P=0.286). Significant risk factors included shielding (HR: 1.52, 95% CI: 1.40, 1.64, P ≤0.001), hospitalization for previous infections (HR: 1.20, 95% CI: 1.12, 1.28, P ≤0.001), hospitalizations one year pre-pandemic (HR: 1.34, 95% CI: 1.25, 1.44, P ≤0.001) and glucocorticoid use (HR: 1.17, 95% CI: 1.09, 1.25, P ≤0.001).ConclusionsIndividuals with IA had a lower incidence of COVID-19, probably due to shielding. IA was not associated with increased mortality following COVID-19 infection; being vulnerable (shielded), comorbidities and other factors were associated with increased risk. These key risk factors can identify individuals with IA at greater risk from COVID-19 and advised to shield during high community prevalence.
published_date	2022-06-28T04:21:56Z
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Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality

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