Minority patients with rheumatic diseases have worse COVID-19 outcomes

November 06, 2020

ATLANTA -- New research at ACR Convergence, the American College of Rheumatology's annual meeting, reveals that people of color with rheumatic disease have worse health outcomes from COVID-19 infection, are more likely to be hospitalized to treat their coronavirus infection, and are more likely to require invasive ventilator treatment.

COVID-19 is the disease caused by the novel SARS-CoV-2 coronavirus. As part of the response to the global pandemic, the rheumatology community launched the COVID-19 Global Rheumatology Alliance physician registry, an international collection of data on patients with rheumatic diseases who have been diagnosed with COVID-19. These data have been used for a number of studies that clarify how people with rheumatic diseases, many of whom take immunosuppressant drugs to control their conditions, are affected by COVID-19.

People with rheumatic disease, particularly those on immunosuppressants, are may be at higher risk for severe infections. What doctors and their patients do not know is why.. This new study used the data collected in the registry to determine if patients are more likely to experience more severe outcomes from COVID-19, and to learn if COVID-19 health outcomes vary by race and ethnicity for patients in the United States (U.S.).

"At the time we were examining data from the registry, there was growing attention on the disproportionate impact of COVID-19 among racial/ethnic minorities in the U.S.," says study co-author Milena Gianfrancesco, PhD, MPH, Assistant Adjunct Professor at the University of California, San Francisco School of Medicine. "We know that racial/ethnic minority rheumatic disease patients experience higher risk and disease severity in general. We were interested in examining whether the inordinate burden of COVID-19 also affected this susceptible population. Understanding disparities in COVID-19 outcomes can help us identify vulnerable populations and ensure that patients at high risk are adequately tested and treated."

The study included 694 U.S. patients who were defined as white, Black, Latinx or other race/ethnicity from the global rheumatology registry from March 24 to May 22, 2020. The researchers examined COVID-19 outcomes, including whether patients were hospitalized, required ventilation support such as supplementary oxygen and/or invasive ventilation, and if they died or survived their coronavirus infection. They controlled the data for age, sex, smoking status and rheumatic disease diagnoses (including rheumatoid arthritis, lupus, psoriatic arthritis, ankylosing spondylitis and others). They also controlled data for other common health problems that affect people with rheumatic diseases, such as cardiovascular disease, hypertension, lung disease, diabetes, and chronic renal insufficiency or end-stage renal disease. They also looked at arthritis medications that patients used, including immunosuppressants. The study's data also included each patient's level of rheumatic disease activity, or if their inflammatory arthritis was in remission, low, moderate or high.

According to the study's findings, people with rheumatic disease who are of racial or ethnic minorities were more likely to experience poor health outcomes from COVID-19 infection, including hospitalization and necessary ventilation support, compared to white patients. Black and Latinx patients had 2.7 and 1.98 higher odds, respectively, of needing hospitalization for COVID-19 compared to whites. Black and Latinx patients had threefold increased odds of needing ventilation support compared to whites. The study found no differences in mortality rates based on race or ethnicity.

"Bringing these results to light will hopefully lead to actionable changes within the rheumatology community and beyond," says Dr. Gianfrancesco. "We need to be sure that patients who are at high risk of severe COVID-19 outcomes have access to testing, treatment and a vaccine when one is eventually available. I would also add that rheumatology providers can be advocates and trusted allies for their patients. They can ensure that patients are aware of disease risks by providing materials in multiple languages."
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About ACR Convergence

ACR Convergence, the ACR's annual meeting, is where rheumatology meets to collaborate, celebrate, congregate, and learn. Join ACR for an all-encompassing experience designed for the entire rheumatology community. ACR Convergence is not just another meeting - it's where inspiration and opportunity unite to create an unmatched educational experience. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (#ACR20).

About the American College of Rheumatology

The American College of Rheumatology (ACR) is an international medical society representing over 7,700 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.

ABSTRACT: Race/ethnicity Is Associated with Poor Health Outcomes Amongst Rheumatic Disease Patients Diagnosed with COVID-19 in the US: Data from the COVID-19 Global Rheumatology Alliance Physician-Reported Registry

Background/Purpose:

Individuals with rheumatic disease, particularly those on immunosuppressive medications, have a higher risk of developing severe infections. However, whether these patients experience more severe outcomes of COVID-19 is unknown, as is whether outcomes vary by race/ethnicity as has been demonstrated in the general United States (US) population. The aim of this study was to examine the association between race/ethnicity and COVID-19 hospitalization, ventilation status, and mortality in people with rheumatic disease using data from the largest case series to date.

Methods: Patients with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance physician registry from March 24, 2020 to May 22, 2020 were included. The analysis was limited to patients in the US. Race/ethnicity was defined as white, black, Latinx and other. COVID-19 outcomes included hospitalization status (yes/no), requirement for ventilatory support (not hospitalized/no supplementary oxygen; supplementary oxygen or non-invasive ventilation; invasive ventilation/ECMO), and death (yes/no). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of hospitalization; ordinal logistic regression was used to estimate ORs and 95% CIs of ventilatory support; and Poisson models were used to estimate ORs and 95% CIs of mortality. All models were controlled for age, sex, smoking status, rheumatic disease diagnosis (RA, SLE, PsA, AS or other spondyloarthritis, other), comorbidities (hypertension/cardiovascular disease, lung disease, diabetes, and chronic renal insufficiency/end stage renal disease), rheumatic disease medications taken prior to infection (conventional synthetic DMARD (csDMARD) monotherapy; biologic and targeted small molecule DMARD monotherapy (b/tsDMARD); csDMARD + b/tsDMARD combination therapy), NSAID use, prednisone-equivalent glucocorticoid use, and rheumatic disease activity (remission/low vs. moderate/high).

Results: A total of 694 patients were included. Disease characteristics and outcomes by race/ethnicity are shown in Table 1. In multivariable models, racial/ethnic minorities were more likely to experience poor outcomes, including hospitalization and requirement for ventilatory support, compared to white patients (Table 2). Black and Latinx patients had 2.70 and 1.98 higher odds of being hospitalized compared to white patients, respectively (P< 0.01, P=0.01). Black and Latinx patients also had a three-fold increased odds of requiring ventilatory support compared to white patients (P< 0.01). No differences in mortality based on race/ethnicity were found.

Conclusions: Similar to findings in the general US population, we found that racial/ethnic minority patients with rheumatic disease had increased odds of hospitalization and invasive ventilation in the rheumatic disease population even after adjustment for disease and comorbidities. These results further illustrate health disparities related to COVID-19 and suggest that attention should be drawn to addressing the needs of vulnerable populations during public health emergencies.

American College of Rheumatology

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