RISK FACTORS FOR INFECTION AND HEALTH IMPACTS OF THE COVID-19 PANDEMIC IN PEOPLE WITH AUTOIMMUNE DISEASES.

Autor:	Fitzgerald KC; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Mecoli CA; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Douglas M; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Harris S; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Aravidis B; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Albayda J; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Sotirchos ES; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Hoke A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Orbai AM; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Petri M; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Christopher-Stine L; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Baer AN; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Paik JJ; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Adler BL; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Tiniakou E; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Timlin H; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Bhargava P; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Newsome SD; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Venkatesan A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Chaudhry V; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Lloyd TE; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Pardo CA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Stern BJ; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Lazarev M; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Truta B; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Saidha S; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Chen ES; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Sharp M; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Gilotra N; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Kasper EK; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA., Gelber AC; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Bingham CO 3rd; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Shah AA; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA., Mowry EM; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2021 Feb 05. Date of Electronic Publication: 2021 Feb 05.
DOI:	10.1101/2021.02.03.21251069
Abstrakt:	Background: People with autoimmune or inflammatory conditions who take immunomodulatory/suppressive medications may have a higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences. Objective: Assess whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterize pandemic-associated changes to care. Design: Longitudinal registry study. Participants: 4666 individuals with autoimmune or inflammatory conditions followed by specialists in neurology, rheumatology, cardiology, pulmonology or gastroenterology at Johns Hopkins. Measurements: Periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. Results: A total of 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medication exposure) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in multivariable models incorporating behavior and other potential confounders (OR: 1.43; 95%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 chronic kidney disease (OR: 1.76; 95%CI: 1.04, 2.97) were each associated with higher odds of COVID-19. Pandemic-related disruption to care was common. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions. Individuals experiencing changes to employment or income were at highest odds of care disruption. Limitations: Results may not be generalizable to all patients with autoimmune or inflammatory conditions. Information was self-reported. Conclusions: Exposure to glucocorticoids 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.
Databáze:	MEDLINE
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