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

Author

Rheumatology (Oxford). 2020 Dec 4;keaa855. doi: 10.1093/rheumatology/keaa855.Online ahead of print.

Emily Peach 1Megan Rutter 2Peter Lanyon 3Matthew J Grainge 4Richard Hubbard 5Jeanette Aston 6Mary Bythell 7Sarah Stevens 8Fiona Pearce 9

Author Information

1 Research Fellow, Division of Epidemiology and Public Health, University of Nottingham, UK.

2 Clinical Research Fellow, Division of Epidemiology and Public Health, University of Nottingham, UK.

3 Consultant Rheumatologist and Honorary Clinical Associate Professor, Nottingham University Hospitals NHS Trust, Nottingham, UK.

4 Associate Professor in Medical Statistics, Division of Epidemiology and Public Health, University of Nottingham UK.

5 Professor of Epidemiology and Honorary Respiratory Consultant, Division of Epidemiology and Public Health, University of Nottingham UK.

6 NCARDRS rare disease data liaison, National Disease Registration Service, Public Health England.

7 NCARDRS Head of Rare Disease, National Disease Registration Service, Public Health England.

8 Interim Deputy Director, National, Disease Registration Service, Public Health England.

9 Clinical Associate Professor of Rheumatology Epidemiology, Division of Epidemiology and Public Health, University of Nottingham UK.

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 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 01/03/2020. 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%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised 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 healthcare services.