COVID-19 infection, admission and death and the impact of corticosteroids amongst people with rare autoimmune rheumatic disease during the second wave of covid-19 in England: results from the RECORDER Project

Rutter, Megan; Lanyon, Peter C.; Grainge, Matthew J; Hubbard, Richard; Bythell, Mary; Stilwell, Peter; Aston, Jeanette; McPhail, Sean; Stevens, Sarah; Pearce, Fiona A

Abstract

Objectives
To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the second wave of the COVID-19 pandemic in England, and describe the impact of corticosteroids on outcomes.

Methods
Hospital Episode Statistics data were used to identify people alive 01 August 2020 with ICD-10 codes for RAIRD from the whole population of England. Linked national health records were used to calculate rates and rate ratios of COVID-19 infection and death up to 30 April 2021. Primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. NHS Digital and Office for National Statistics general population data were used for comparison. The association between 30-day corticosteroid usage and COVID-19-related death, COVID-19-related hospital admissions and all-cause deaths were also described.

Results
Of 168 330 people with RAIRD, 9,961 (5.92%) had a positive COVID-19 PCR test. The age-standardised infection rate ratio between RAIRD and the general population was 0.99 (95% CI 0.97–1.00). 1,342 (0.80%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardised mortality rate for COVID-19-related death was 2.76 (2.63–2.89) times higher than in the general population. There was a dose-dependent relationship between 30-day corticosteroid usage and COVID-19-related death. There was no increase in deaths due to other causes.

Conclusions
During the second wave of COVID-19 in England, people with RAIRD had the same risk of COVID-19 infection but a 2.76-fold increased risk of COVID-19-related death compared with the general population, with corticosteroids associated with increased risk.

Citation

Rutter, M., Lanyon, P. C., Grainge, M. J., Hubbard, R., Bythell, M., Stilwell, P., Aston, J., McPhail, S., Stevens, S., & Pearce, F. A. (2023). COVID-19 infection, admission and death and the impact of corticosteroids amongst people with rare autoimmune rheumatic disease during the second wave of covid-19 in England: results from the RECORDER Project. Rheumatology, 62(12), 3828-3837. https://doi.org/10.1093/rheumatology/kead150

• Journal Article Type: Article
• Acceptance Date: Mar 20, 2023
• Online Publication Date: Apr 5, 2023
• Publication Date: 2023-12
• Deposit Date: Mar 23, 2023
• Publicly Available Date: Apr 6, 2023
• Journal: Rheumatology
• Electronic ISSN: 1462-0324
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 62
• Issue: 12
• Pages: 3828-3837
• DOI: https://doi.org/10.1093/rheumatology/kead150
• Keywords: COVID-19, coronavirus, mortality, rare autoimmune rheumatic diseases, epidemiology, shielding, infection
• Public URL: https://nottingham-repository.worktribe.com/output/18812697
• Publisher URL: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/kead150/7108765