Risk Factors for Infection and Health Impacts of the COVID-19 Pandemic in People with Autoimmune Diseases

{ 'institution': [{'name': 'medRxiv'}], 'indexed': {'date-parts': [[2023, 2, 5]], 'date-time': '2023-02-05T00:28:12Z', 'timestamp': 1675556892557}, 'posted': {'date-parts': [[2021, 2, 5]]}, 'group-title': 'Infectious Diseases (except HIV/AIDS)', 'reference-count': 30, 'publisher': 'Cold Spring Harbor Laboratory', 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'accepted': {'date-parts': [[2021, 2, 5]]}, 'abstract': '<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>Assess ' 'whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and ' 'characterize pandemic-associated changes to ' 'care.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Longitudinal ' 'registry study</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>4666 ' 'individuals with autoimmune or inflammatory conditions followed by specialists in neurology, ' 'rheumatology, cardiology, pulmonology or gastroenterology at Johns ' 'Hopkins</jats:p></jats:sec><jats:sec><jats:title>Measurements</jats:title><jats:p>Periodic ' 'surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing ' 'and outcomes, social behaviors, and disruptions to ' 'healthcare</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Limitations</jats:title><jats:p>Results ' 'may not be generalizable to all patients with autoimmune or inflammatory conditions. ' 'Information was ' 'self-reported.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>', 'DOI': '10.1101/2021.02.03.21251069', 'type': 'posted-content', 'created': {'date-parts': [[2021, 2, 7]], 'date-time': '2021-02-07T10:44:09Z', 'timestamp': 1612694649000}, 'source': 'Crossref', 'is-referenced-by-count': 3, 'title': 'RISK FACTORS FOR INFECTION AND HEALTH IMPACTS OF THE COVID-19 PANDEMIC IN PEOPLE WITH AUTOIMMUNE ' 'DISEASES', 'prefix': '10.1101', 'author': [ { 'ORCID': 'http://orcid.org/0000-0003-3137-0322', 'authenticated-orcid': False, 'given': 'Kathryn C.', 'family': 'Fitzgerald', 'sequence': 'first', 'affiliation': []}, {'given': 'Christopher A.', 'family': 'Mecoli', 'sequence': 'additional', 'affiliation': []}, {'given': 'Morgan', 'family': 'Douglas', 'sequence': 'additional', 'affiliation': []}, {'given': 'Samantha', 'family': 'Harris', 'sequence': 'additional', 'affiliation': []}, {'given': 'Berna', 'family': 'Aravidis', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jemima', 'family': 'Albayda', 'sequence': 'additional', 'affiliation': []}, {'given': 'Elias S.', 'family': 'Sotirchos', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ahmet', 'family': 'Hoke', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ana-Maria', 'family': 'Orbai', 'sequence': 'additional', 'affiliation': []}, {'given': 'Michelle', 'family': 'Petri', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lisa', 'family': 'Christopher-Stine', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alan N.', 'family': 'Baer', 'sequence': 'additional', 'affiliation': []}, {'given': 'Julie J.', 'family': 'Paik', 'sequence': 'additional', 'affiliation': []}, {'given': 'Brittany L.', 'family': 'Adler', 'sequence': 'additional', 'affiliation': []}, {'given': 'Eleni', 'family': 'Tiniakou', 'sequence': 'additional', 'affiliation': []}, {'given': 'Homa', 'family': 'Timlin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Pavan', 'family': 'Bhargava', 'sequence': 'additional', 'affiliation': []}, {'given': 'Scott D.', 'family': 'Newsome', 'sequence': 'additional', 'affiliation': []}, {'given': 'Arun', 'family': 'Venkatesan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Vinay', 'family': 'Chaudhry', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thomas E.', 'family': 'Lloyd', 'sequence': 'additional', 'affiliation': []}, {'given': 'Carlos A.', 'family': 'Pardo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Barney J.', 'family': 'Stern', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mark', 'family': 'Lazarev', 'sequence': 'additional', 'affiliation': []}, {'given': 'Brindusa', 'family': 'Truta', 'sequence': 'additional', 'affiliation': []}, {'given': 'Shiv', 'family': 'Saidha', 'sequence': 'additional', 'affiliation': []}, {'given': 'Edward S.', 'family': 'Chen', 'sequence': 'additional', 'affiliation': []}, {'given': 'Michelle', 'family': 'Sharp', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nisha', 'family': 'Gilotra', 'sequence': 'additional', 'affiliation': []}, {'given': 'Edward K.', 'family': 'Kasper', 'sequence': 'additional', 'affiliation': []}, {'given': 'Allan C.', 'family': 'Gelber', 'sequence': 'additional', 'affiliation': []}, { 'suffix': 'III', 'given': 'Clifton O.', 'family': 'Bingham', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ami A.', 'family': 'Shah', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ellen M.', 'family': 'Mowry', 'sequence': 'additional', 'affiliation': []}], 'member': '246', 'reference': [ { 'key': '2021020805050885000_2021.02.03.21251069v1.1', 'doi-asserted-by': 'crossref', 'unstructured': 'Sormani, M. 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