Introduction & Objectives
People with rheumatic disease, particularly those receiving immunosuppressive medications, have a higher risk of developing severe infections. Therefore, several reports have examined the prevalence of coronavirus disease 2019 (COVID-19) in patients with rheumatic diseases. Most literature suggests a prevalence of COVID-19 in the rheumatic disease population similar to that in the general population, but one study indicated a slightly higher risk of mortality in individuals with rheumatic diseases, and some immunosuppressive medications may place patients at higher risk of hospitalization. Rheumatic disease patients with comorbidities also have higher odds of poor outcomes.
Research has illustrated the disproportionate burden of COVID-19 in racial/ethnic minority populations. COVID-19-related deaths are significantly higher in communities with higher proportions of Black, Latinx, Asian American or other racial/ethnic minorities.
This study was undertaken to examine the association between race/ethnicity and COVID-19 hospitalization, ventilation status and mortality in people with rheumatic disease.
Methods
U.S. patients with rheumatic disease and COVID-19 entered into the COVID-19 Global Rheumatology Alliance physician registry between March 24, 2020, and Aug. 26, 2020, were included in this analysis.
Physicians indicated whether the diagnosis of COVID-19 was based on polymerase chain reaction, antibody testing, metagenomic testing, computed tomography scan, laboratory assay or a presumptive diagnosis based only on characteristic symptoms.
Race/ethnicity was reported by the physician entering the case, and multiple categories could be selected. The researchers defined race/ethnicity as white, Black, Latinx, Asian or other/mixed race.
Outcome measures included hospitalization, requirement for ventilatory support and death. Multivariable regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for age, sex, smoking status, rheumatic disease diagnosis, comorbidities, medication use prior to infection and rheumatic disease activity.
Results
A total of 1,324 patients were included in this study, of whom 36% were hospitalized and 6% died; 26% of hospitalized patients required mechanical ventilation. In multivariable models, Black patients (OR 2.74 [95% CI 1.90–3.95]), Latinx patients (OR 1.71 [95% CI 1.18–2.49]) and Asian patients (OR 2.69 [95% CI 1.16–6.24]) had higher odds of hospitalization than white patients. Latinx patients also had threefold increased odds of requiring ventilatory support (OR 3.25 [95% CI 1.75–6.05]). No differences in mortality based on race/ethnicity were found, although power may have been limited to detect associations.
Conclusion
Similar to findings in the general U.S. population, racial/ethnic minorities with rheumatic disease and COVID-19 had increased odds of hospitalization and ventilatory support. These results illustrate significant health disparities related to COVID-19 in people with rheumatic diseases.
Proactive measures to actively treat and focus attention on the care of these patients are urgently needed. Strategies to be considered include targeted counseling to reduce the risk of COVID-19 transmission, ensuring patients with rheumatic diseases can access COVID-19 testing, educating patients to access care early in the course of COVID-19 illness, managing immunosuppressive drugs and controlling disease activity.
