Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 COVID-19 pandemic

Peach, Emily; Rutter, Megan; Lanyon, Peter; Grainge, Matthew J; Hubbard, Richard; Aston, Jeanette; Bythell, Mary; Stevens, Sarah; Pearce, Fiona

Abstract

Objectives: To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods: We conducted a cohort study in Hospital Episode Statistics for England from 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results: We included 168 691 people with a recorded diagnosis of RAIRD alive on 1 March 2020. Their median age was 61.7 (IQR 41.5-75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. A total of 1815 (1.1%) participants died during March and April 2020. The age-standardized mortality rate (ASMR) among people with RAIRD (3669.3; 95% CI: 3500.4, 3838.1 per 100 000 person-years) was 1.44 (95% CI: 1.42, 1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion: The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to health-care services.

Citation

Peach, E., Rutter, M., Lanyon, P., Grainge, M. J., Hubbard, R., Aston, J., …Pearce, F. (2021). Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 COVID-19 pandemic. Rheumatology, 60(4), 1902–1909. https://doi.org/10.1093/rheumatology/keaa855

• Journal Article Type: Article
• Acceptance Date: Nov 21, 2020
• Online Publication Date: Dec 4, 2020
• Publication Date: 2021-04
• Deposit Date: Nov 23, 2020
• Publicly Available Date: Dec 5, 2021
• Journal: Rheumatology
• Electronic ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Issue: 4
• Pages: 1902–1909
• DOI: https://doi.org/10.1093/rheumatology/keaa855
• Keywords: Pharmacology (medical); Rheumatology
• Public URL: https://nottingham-repository.worktribe.com/output/5066912
• Publisher URL: https://academic.oup.com/rheumatology/article/60/4/1902/6015211
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Rheumatology following peer review. The version of record, Emily Peach, Megan Rutter, Peter Lanyon, Matthew J Grainge, Richard Hubbard, Jeanette Aston, Mary Bythell, Sarah Stevens, Fiona Pearce, Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic, Rheumatology, , keaa855 is available online at: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keaa855/6015211