Introduction & Objectives
The impact of COVID-19 has been amplified by social disparities in the U.S. Risk factors for higher morbidity and mortality with COVID-19 include being older than 65 years, obesity and such comorbidities as hypertension, diabetes mellitus and lung disease. Patients with rheumatic diseases could especially be at risk of complications from COVID-19 due to immune system dysfunction and concomitant use of immunomodulatory therapies.
Latinos represent the largest and fastest growing minority population in the U.S. Latinos living in the U.S. not only have a higher prevalence of obesity, diabetes and kidney diseases, but lower rates of insurance coverage than the general population. Latinos are more likely to work in positions considered to be essential, increasing their risk of exposure to infections. Such jobs often provide limited or no sick time, further perpetuating the increased risk to Latino workers. The combination of these factors has led to Latino patients being disproportionately affected by COVID-19, resulting in increased incidence, severity of disease and mortality
In short, Latino patients are overrepresented among cases of COVID-19 and are at an increased risk of severe disease. The prevalence of COVID-19 in Latinos with rheumatic diseases is poorly reported. This study was undertaken to characterize COVID-19 clinical features and outcomes in Latino patients with rheumatic diseases.
Methods
Fike et al. conducted a retrospective study of Latino patients with rheumatic diseases from an existing observational cohort in the Washington, D.C., area. Patients seen between April 1, 2020, and Oct. 15, 2020, were analyzed. The researchers reviewed demographic characteristics, body mass index (BMI), comorbidities and use of immunomodulatory therapies. An exploratory classification and regression tree (CART) analysis and logistic regression analyses were performed to identify risk factors for COVID-19 and rheumatic disease flare.
Results
Of 178 Latino patients with rheumatic diseases, 32 (18%) were identified as having COVID-19, and the incidence rate of infection was found to be threefold higher than in the general Latino population. All but two patients were receiving immunomodulatory treatment at the time of their COVID-19 diagnosis. Immunomodulatory medications were discontinued during COVID-19 infection in 14 of 30 patients (46.7%). No patients required intensive care unit-level care.
A CART analysis and multivariable logistic regression analysis identified a BMI of >30.35 kg/m2 as a risk factor for COVID-19 (odds ratio [OR] 3.37 [95% confidence interval (95% CI) 1.5–7.7]; P=0.004). Among the nonobese patients, being older than 40 years was identified as the main risk factor.