Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study.

Autor:	Izadi Z; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Gianfrancesco MA; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Schmajuk G; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA.; San Francisco VA Medical Center, San Francisco, CA, USA., Jacobsohn L; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Katz P; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Rush S; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Ja C; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Taylor T; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Shidara K; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA., Danila MI; Division of Clinical Immunology and Rheumatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA., Wysham KD; VA Puget Sound Health Care System and Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA., Strangfeld A; German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany., Mateus EF; Portuguese League Against Rheumatic Diseases, Lisbon, Portugal., Hyrich KL; Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.; National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester-NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK., Gossec L; INSERM, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France.; Rheumatology Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France., Carmona L; Instituto de Salud Musculoesquelética, Madrid, Spain., Lawson-Tovey S; Centre for Genetics and Genomics Versus Arthritis, University of Manchester, Manchester, UK.; Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.; National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester-NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK., Kearsley-Fleet L; Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK., Schaefer M; German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany., Al-Emadi S; Hamad Medical Corporation, Doha, Qatar., Sparks JA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Hsu TY; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Patel NJ; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Wise L; University of Southern California, Los Angeles, CA, USA., Gilbert E; Division of Rheumatology, Mayo Clinic, Jacksonville, FL, USA., Duarte-García A; Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.; Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA., Valenzuela-Almada MO; Division of Rheumatology, Mayo Clinic, Rochester, MN, USA., Ugarte-Gil MF; School of Medicine, Universidad Científica del Sur, Lima, Peru.; Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru., Ljung L; Department of Public Health and Clinical Medicine and Department of Rheumatology, Umeå University, Umeå, Sweden.; Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden., Scirè CA; Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy., Carrara G; Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy., Hachulla E; INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France, U1286-INFINITE-Institute for Translational Research in Inflammation, Université de Lille, Lille, France., Richez C; Department of Rheumatology, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeux, France.; UMR-CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France., Cacoub P; INSERM 959, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France., Thomas T; Département de Médecine Interne et Immunologie Clinique, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France.; Centre National de Références Maladies Autoimmunes systémiques rares, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France.; Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France.; Inflammation-Immunopathology-Biotherapy Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France.; Department of Rheumatology, Hôpital Nord, Centre Hospitalier Universitaire Saint-Etienne, INSERM U1059, Lyon University, Saint-Etienne, France., Santos MJ; Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal.; Instituto de Medicina Molecular, Faculdade Medicina Lisboa, University of Lisbon, Lisbon, Portugal., Bernardes M; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.; Rheumatology Department, Centro Hospitalar-Universitário de São João, Porto, Portugal., Hasseli R; Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany., Regierer A; German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany., Schulze-Koops H; Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-University Munich, Munich, Germany., Müller-Ladner U; Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany., Pons-Estel G; Argentine Society of Rheumatology, Buenos Aires, Argentina., Tanten R; Hospital Francisco Lopez Lima, General Roca, Argentina., Nieto RE; Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Santa Fe, Argentina., Pisoni CN; Rheumatology and Immunology Section, Centro de Educación Médica e Investigaciones Clínicas 'Norberto Quirno', Buenos Aires, Argentina., Tissera YS; Servicio de Clínica Médica, Unidad de Reumatología del Hospital Córdoba and Sanatorio Parque de Córdoba, Córdoba, Argentina., Xavier R; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Lopes Marques CD; Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil., Pileggi GCS; Hospital São Paulo, Universidade Federal de São Paulo, Brazil., Robinson PC; University of Queensland Medical School, Brisbane, QLD, Australia.; Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia., Machado PM; University College London, University College London Hospitals NHS Foundation Trust, Northwick Park Hospital, London North-West University Healthcare NHS Trust, London, UK., Sirotich E; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.; Canadian Arthritis Patient Alliance, Toronto, ON, Canada., Liew JW; Boston University School of Medicine, Boston, MA, USA., Hausmann JS; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.; Boston Children's Hospital, Boston, MA, USA., Sufka P; HealthPartners, St Paul, MN, USA., Grainger R; Department of Medicine, University of Otago Wellington, Wellington, New Zealand., Bhana S; Pfizer, New York, NY, USA., Gore-Massy M; Affiliation Lupus Foundation of America, Washington, DC, USA., Wallace ZS; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA., Yazdany J; Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, USA.
Jazyk:	angličtina
Zdroj:	The Lancet. Rheumatology [Lancet Rheumatol] 2022 Sep; Vol. 4 (9), pp. e603-e613. Date of Electronic Publication: 2022 Jul 25.
DOI:	10.1016/S2665-9913(22)00192-8
Abstrakt:	Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m 3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02-1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00-1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88-1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44-0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74-0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69-0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1-9·5]; p=0·14). Interpretation: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities. Funding: American College of Rheumatology and European Alliance of Associations for Rheumatology. Competing Interests: MID reports research support from Pfizer for unrelated work. AS reports grants from a consortium of 13 companies (AbbVie, Bristol Myers Squibb, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, Merck, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB) supporting the German RABBIT register, and personal fees from lectures for AbbVie, Merck, Roche, Bristol Myers Squibb, and Pfizer, outside of the submitted work. EFM reports that the Portuguese League Against Rheumatic Diseases received support for specific activities: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal SA, Merck, Celgene, Medac, Pharmakern, the Global Alliance for Patient Access; grants and non-financial support from Pfizer; and non-financial support from Grünenthal GmbH, outside of the submitted work. KLH reports receiving speaker fees from Abbvie and grant income from Bristol Myers Squibb, UCB, and Pfizer, unrelated to this work. KLH is also supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre. LG reports research grants from Amgen, Galapagos, Janssen, Lilly, Pfizer, Sandoz, and Sanofi; and consulting fees from AbbVie, Amgen, Bristol Myers Squibb, Biogen, Celgene, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB, all unrelated to this work. LC has not received fees or personal grants from any laboratory, but her institute works by contract for laboratories among other institutions, such as Abbvie Spain, Eisai, Gebro Pharma, Merck Sharp & Dohme España, SA Pharma, Novartis Farmaceutica, Pfizer, Roche Farma, Sanofi, Aventis, Astellas Pharma, Actelion Pharmaceuticals España, Grünenthal GmbH, and UCB Pharma. JAS has performed consultancy for AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Inova Diagnostics, Janssen, and Optum, unrelated to this work. LW has received consulting or speaking fees from Aurinia Pharma, outside of the submitted work. MFU-G reports grant or research support from Jannsen and Pfizer, unrelated to this work. The Swedish Rheumatology Quality Register, with LL as register holder, has agreements with Abbvie, Amgen, Eli Lilly, Gilead, Novartis, Pfizer, Sanofi, Sobi, and UCB for register data analyses, unrelated to this work. CR has received consulting or speaker fees from Abbvie, Amgen, AstraZeneca, BMS, Biogen, Eli Lilly, Glenmark, GlaxoSmithKline, Merck, Mylan, and Pfizer; and grants from Biogen, Lilly, and Nordic Pharma, all unrelated to this work. MJS has received speaker fees from Abbvie, AstraZeneca, Novartis, and Pfizer. AR has received speaker fees from Janssen, Pfizer, and Novartis. GP-E reports reports personal consulting fees, speaking fees, or both from Pfizer, GlaxoSmithKline, Janssen, Sandoz, and Sanofi, outside of the submitted work. PCR reports personal consulting fees, speaking fees, or both from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB; and travel assistance from Roche. PMM has received consulting fees, speaker fees, or both from Abbvie, Bristol Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, and UCB, unrelated to this work. PMM is supported by the NIHR University College London Hospitals Biomedical Research Centre. ES is a Board Member of the Canadian Arthritis Patient Alliance, a patient-run, volunteer-based organisation whose activities are largely supported by independent grants from pharmaceutical companies. JWL has received research funding from Pfizer, outside of the submitted work. JSH is supported by grants from the Rheumatology Research Foundation and has salary support from the Childhood Arthritis and Rheumatology Research Alliance. JSH has performed consulting for Novartis, Sobi, and Biogen, unrelated to this work. PS reports honorarium for doing social media for American College of Rheumatology journals. RG reports personal fees, speaking fees, or both from Abbvie, Janssen, Novartis, Pfizer, and Cornerstones; and travel assistance from Pfizer. SB reports non-branded consulting fees for AbbVie, Horizon, and Novartis; and is employed by Pfizer. ZSW reports grant support from Bristol Myers Squibb and Principia–Sanofi; and performed consultancy for Viela Bio and MedPace, outside of the submitted work. ZSW's work is supported by grants from the National Institutes of Health. JY has performed consulting for Eli Lilly, Pfizer, Aurinia, and AstraZeneca, outside of the submitted work. All other authors declare no competing interests. (Published by Elsevier Ltd.)
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