COVID-19 Death Rate Higher in People with Certain Inflammatory

Image: Professor Sinéad Langan

From the University of Oxford

A new study published in The Lancet Rheumatology with the involvement of researchers from the University of Oxford has found that people with certain inflammatory immune conditions affecting the joints, bowel and skin, such as rheumatoid arthritis, may have been more at risk of dying or needing hospital care if they got COVID-19 before vaccination compared with the general population.

The findings are based on an analysis of 17 million patient GP records in England during the first phase of the pandemic from March-September 2020, when the UK was in lockdown and before vaccines were available. More than 1 million patients in the analysis had immune mediated inflammatory diseases (IMIDs). These included inflammatory bowel disease such as Crohn’s disease and ulcerative colitis, conditions affecting the joints such as rheumatoid arthritis, and skin conditions including psoriasis.

After accounting for demographic factors such as age, sex, and smoking status, the research suggests that people with IMIDs affecting the bowel, joints and skin had a 23 per cent increased risk of COVID-19-related death and 23 per cent increased risk of COVID-related hospitalisation compared to people without IMIDs before the introduction of vaccines and antiviral treatments. People with inflammatory joint disease appeared to be at greatest risk compared to those with gut or skin disease.

Study author Professor Sinéad Langan, Wellcome Senior Clinical Fellow and Professor of Clinical Epidemiology at the London School of Hygiene & Tropical Medicine, said, “During the height of the pandemic in England in 2020, many people with inflammatory conditions affecting the bowel, joints and skin were advised to stay at home and shield because doctors did not know how COVID-19 would affect them, or what the effects of drugs such as immune modifying therapies used to treat IMIDs would be.

“Our study provides the most accurate assessment of risk of severe COVID-19 before vaccination in people with IMIDs and with the drugs used for their treatment.

“We hope this analysis will help to inform evidence-based policy as we continue to live with COVID-19.”

The authors acknowledged limitations of the study including the fact that people with these conditions may have avoided infection with COVID-19 and that other health issues such as cardiovascular disease and diabetes may affect COVID-19 outcomes for people with IMIDs, as well as the potential for misclassification of prescriptions or medication on the patient records.

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