Eng Hooi Tan1, Anthony G Sena2,3, Albert Prats-Uribe1, Seng Chan You4, Waheed-Ul-Rahman Ahmed5,6, Kristin Kostka7, Christian Reich7, Scott L Duvall8,9, Kristine E Lynch8,9, Michael E Matheny10,11, Talita Duarte-Salles12, Sergio Fernandez Bertolin12, George Hripcsak13,14, Karthik Natarajan13,14, Thomas Falconer13, Matthew Spotnitz13, Anna Ostropolets13, Clair Blacketer2,3, Thamir M Alshammari15, Heba Alghoul16, Osaid Alser17, Jennifer C E Lane1, Dalia M Dawoud18, Karishma Shah5, Yue Yang19, Lin Zhang20,21, Carlos Areia22, Asieh Golozar23,24, Martina Recalde12,25, Paula Casajust26, Jitendra Jonnagaddala27, Vignesh Subbian28, David Vizcaya29, Lana Y H Lai30, Fredrik Nyberg31, Daniel R Morales32, Jose D Posada33, Nigam H Shah33, Mengchun Gong34, Arani Vivekanantham5, Aaron Abend35, Evan P Minty36, Marc Suchard37, Peter Rijnbeek3, Patrick B Ryan2,13, Daniel Prieto-Alhambra1. 1. Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, OX3 7LD, UK. 2. Janssen Research and Development, Titusville, NJ USA. 3. Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands. 4. Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea. 5. Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, OX3, 7LD, UK. 6. College of Medicine and Health, University of Exeter, St Luke's, 2LU, USA. 7. Real World Solutions, IQVIA, Cambridge, MA, USA. 8. VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, UT, USA. 9. Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. 10. Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA. 11. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. 12. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain. 13. Department of Biomedical Informatics, Columbia University, New York, NY, USA. 14. New York-Presbyterian Hospital, New York, NY, USA. 15. Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia. 16. Faculty of Medicine, Islamic University of Gaza, Palestine. 17. Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA. 18. Faculty of Pharmacy, Cairo University, Cairo, Egypt. 19. Digital China Health Technologies Co., LTD, Beijing 100085, China. 20. School of Population Medicine and Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China. 21. Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3015, Australia. 22. Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK. 23. Regeneron Pharmaceuticals, NY, USA. 24. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,, Baltimore, MD, USA. 25. Universitat Autonoma de Barcelona, Bellaterra, Spain. 26. Real-World Evidence, Trial Form Support, Barcelona, Spain. 27. School of Public Health and Community Medicine, UNSW Sydney, Australia. 28. College of Engineering, The University of Arizona Tucson, Arizona, USA. 29. Bayer Pharmaceuticals, Sant Joan Despi, Barcelona, Spain. 30. School of Medical Sciences, University of Manchester, UK. 31. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 32. Division of Population Health Sciences, University of Dundee, Dundee, Scotland, UK. 33. Stanford Center for Biomedical Informatics Research, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA. 34. Health Management Institute, Southern Medical University, Guangzhou, China. 35. Autoimmune Registry Inc., Guilford, CT 06437, USA. 36. O'Brien School for Public Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, T2N, 1N4, Canada. 37. Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, CA, USA.
Abstract
OBJECTIVE: Patients with autoimmune diseases were advised to shield to avoid coronavirus disease 2019 (COVID-19), but information on their prognosis is lacking. We characterized 30-day outcomes and mortality after hospitalization with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. METHODS: A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center [USA, Optum (USA), Department of Veterans Affairs (USA), Information System for Research in Primary Care-Hospitalization Linked Data (Spain) and claims data from IQVIA Open Claims (USA) and Health Insurance and Review Assessment (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalized between January and June 2020 with COVID-19, and similar patients hospitalized with influenza in 2017-18 were included. Outcomes were death and complications within 30 days of hospitalization. RESULTS: We studied 133 589 patients diagnosed and 48 418 hospitalized with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5-93.2%), chronic kidney disease (14.0-52.7%) and heart disease (29.0-83.8%) was higher in hospitalized vs diagnosed patients with COVID-19. Compared with 70 660 hospitalized with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2-4.3% vs 6.32-24.6%). CONCLUSION: Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality.
OBJECTIVE: Patients with autoimmune diseases were advised to shield to avoid coronavirus disease 2019 (COVID-19), but information on their prognosis is lacking. We characterized 30-day outcomes and mortality after hospitalization with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. METHODS: A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center [USA, Optum (USA), Department of Veterans Affairs (USA), Information System for Research in Primary Care-Hospitalization Linked Data (Spain) and claims data from IQVIA Open Claims (USA) and Health Insurance and Review Assessment (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalized between January and June 2020 with COVID-19, and similar patients hospitalized with influenza in 2017-18 were included. Outcomes were death and complications within 30 days of hospitalization. RESULTS: We studied 133 589 patients diagnosed and 48 418 hospitalized with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5-93.2%), chronic kidney disease (14.0-52.7%) and heart disease (29.0-83.8%) was higher in hospitalized vs diagnosed patients with COVID-19. Compared with 70 660 hospitalized with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2-4.3% vs 6.32-24.6%). CONCLUSION: Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality.
Keywords:
COVID-19; Observational Health Data Sciences and Informatics (OHDSI); Observational Medical Outcomes Partnership (OMOP); autoimmune condition; hospitalization; mortality; open science
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