Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases.

Autor:	Fitzgerald KC; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Mecoli CA; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Douglas M; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Harris S; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Aravidis B; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Albayda J; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Sotirchos ES; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Hoke A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Orbai AM; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Petri M; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Christopher-Stine L; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Baer AN; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Paik JJ; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Adler BL; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Tiniakou E; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Timlin H; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Bhargava P; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Newsome SD; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Venkatesan A; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Chaudhry V; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Lloyd TE; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Pardo CA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Stern BJ; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Lazarev M; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Truta B; Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Saidha S; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Chen ES; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Sharp M; Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Gilotra N; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Kasper EK; Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Gelber AC; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Bingham CO; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Shah AA; Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Mowry EM; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2022 Feb 11; Vol. 74 (3), pp. 427-436.
DOI:	10.1093/cid/ciab407
Abstrakt:	Background: People with autoimmune or inflammatory conditions taking immunomodulatory/suppressive medications may have higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences. Methods: We included participants with autoimmune or inflammatory conditions followed by specialists at Johns Hopkins. Participants completed periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. We assessed whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterized pandemic-associated changes to care and mental health. Results: In total, 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medications) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in models incorporating behavior and other potential confounders (odds ratio [OR]: 1.43; 95% confidence interval [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 kidney disease (OR: 1.76; 95% CI: 1.04, 2.97) were associated with higher odds of COVID-19. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions therein, which disproportionately affected individuals experiencing changes to employment or income. Conclusions: Glucocorticoid exposure 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. (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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