Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
Por:
Izadi Z., Gianfrancesco M.A., Schmajuk G., Jacobsohn L., Katz P., Rush S., Ja C., Taylor T., Shidara K., Danila M.I., Wysham K.D., Strangfeld A., Mateus E.F., Hyrich K.L., Gossec L., Carmona L., Lawson-Tovey S., Kearsley-Fleet L., Schaefer M., Al-Emadi S., Sparks J.A., Hsu T.Y.-T., Patel N.J., Wise L., Gilbert E., Duarte-García A., Valenzuela-Almada M.O., Ugarte-Gil M.F., Ljung L., Scirè C.A., Carrara G., Hachulla E., Richez C., Cacoub P., Thomas T., Santos M.J., Bernardes M., Hasseli R., Regierer A., Schulze-Koops H., Müller-Ladner U., Pons-Estel G., Tanten R., Nieto R.E., Pisoni C.N., Tissera Y.S., Xavier R., Lopes Marques C.D., Pileggi G.C.S., Robinson P.C., Machado P.M., Sirotich E., Liew J.W., Hausmann J.S., Sufka P., Grainger R., Bhana S., Gore-Massy M., Wallace Z.S., Yazdany J., Dahou B., Gómez G., Roberts K., Baez R.M., Castro Coello V.V., Haye Salinas M.J., Maldonado F.N., Reyes A.A., Alle G., Maldonado Ficco H., Nieto R., Gobbi C., Tissera Y., Pisoni C., Paula A., Albiero J.A., Schmid M.M., Cosatti M., Gamba M.J., Leandro C., Cusa M.A., German N., Bellomio V., Takashima L., Pera M., Cogo K., Gálvez Elkin M.S., Medina M.A., Savio V., Rojas Tessel R., Alamino R.P., Werner M.L., Ornella S., Casalla L., de la Vega M., Severina M., García M., Gonzalez Lucero L., Romeo C., Moyano S., Barbich T., Bertoli A., Baños A., Petruzzelli S., Matellan C., Conti S., Lazaro M.A., Rodriguez Gil G.F., Risueño F., Quaglia M.I., Scafati J., Cuchiaro N.L., Rebak J.E., Pineda S.I., Calvo M.E., Picco E., Yanzi J.G., Maid P., Guaglianone D., Morbiducci J.S., Porta S., Herscovich N., Velasco Zamora J.L., Kisluk B., Castaños Menescardi M.S., Gallo R., Martire M.V., Maldini C., Goizueta C., de la Vega Fernandez S.S., Aeschlimann C., Subils G., Rath E., Piette Y., Devinck M., Maeyaert B., Machado Ribeiro F., Euzebio Ribeiro S.L., Pinheiro M., Ibáñez S., Chassin Trubert A.-M., Dong L., Cajas L., Barešic M., Anic B., Culo M.-I., Pavelic T.A., Stranski K.K., Karanovic B., Vencovsky J., Píchová M., Filkova M., Hamoud H., Vassilopoulos D., Guzman Melgar G.M., So H., Király M., Vojdanian M., Balbir Gurman A., Abutiban F., Zepa J., Bulina I., Bukauskiene L., Zazueta Montiel B.E., Castillo Ortiz A.A., Zamora Tehozol E., Vega Morales D., Cervántes Rosete D., Martín Nares E., Rodriguez Reyna T.S., Rull Gabayet M., Alpízar Rodríguez D., Irazoque F., Jimenez X., Geurts van Bon L., Zijlstra T., Hoekstra M., Al Adhoubi N., Salim B., Giraldo E., Salinas A., Ugarte Gil M., Nowakowski J., Conway R., Flood R., McCarthy G., Felea I., Filipescu I., Rednic S., Groseanu L., Tamas M.M., Mlynarikova V., Skamlova M., Zlnay M., Miceková D., Capova L., Macejova Z., Štenová E., Raffayova H., Belakova G., Strakova E., Sencarová M., Žlnayová S., Sabová A., Spisakova D., Oetterová M., Lukacova O., Bakosova M., Hocevar A., de la Torre Rubio N., Alegre Sancho J.J., Corteguera Coro M., Cobeta Garcia J.C., Torres Martin M.C., Campos J., Gomez Puerta J.A., Yardimci G.K., Akar S., Icacan O.C., ÇELIK S., Vasylets V., Yeoh S.-A., Vandevelde C., Dunt S., Leeder J., Macphie E., Salerno R., Graver C., Williams K., O'Reilly S., Devine K., Tyler J., Warner E., Pilcher J., Patel S., Nikiphorou E., Chadwick L., Jones C.M., Harrison B., Thornton L., O'Kane D., Fusi L., Low A., Horton S., Jatwani S., Baig S., Bajwa H., Berglund V., Dahle A., Dorman W., Hargrove J., Hilton M., Lebedoff N., Leonard S., Morgan J., Pfeifer E., Skemp A., Wilson J., Wolff A., Cepeda E., Todd D., Hare D., Calabrese C., Adams C., Khosroshahi A., Kilian A., White D., Winter M., Fields T., Siegel C., Daver N., Harvey M., Kramer N., Lamore C., Hogarty S., Yeter K., Siddique F., Ban B., Tanner T., Ruderman E., Davis W., Quinet R., Scopelitis E., Toribio K., Webb Detiege T., Zakem J., Abbass K., Kepecs G., Miranda L., Guma M., Haikal A., Mody S., Mueller D., Jayatilleke A., Zell J., Bays A., Dao K., Ezzati F., Parks D., Karp D., Quiceno G., COVID-19 Global Rheumatology Alliance Registry
Publicada:
1 ene 2022
Resumen:
Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18–99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 µg/m3 [95% CI 1·01–1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10–1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02–1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00–1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88–1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44–0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74–0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69–0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1–9·5]; p=0·14). Interpretation: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities. Funding: American College of Rheumatology and European Alliance of Associations for Rheumatology. © 2022 Elsevier Ltd
Filiaciones:
Izadi Z.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Gianfrancesco M.A.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Schmajuk G.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
San Francisco VA Medical Center, San Francisco, CA, United States
Jacobsohn L.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Katz P.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Rush S.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Ja C.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Taylor T.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Shidara K.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Danila M.I.:
Division of Clinical Immunology and Rheumatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
Wysham K.D.:
VA Puget Sound Health Care System and Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, United States
Strangfeld A.:
German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
Mateus E.F.:
Portuguese League Against Rheumatic Diseases, Lisbon, Portugal
Hyrich K.L.:
Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester–NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
Gossec L.:
INSERM, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
Rheumatology Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
Carmona L.:
Instituto de Salud Musculoesquelética, Madrid, Spain
Lawson-Tovey S.:
Centre for Genetics and Genomics Versus Arthritis, University of Manchester, Manchester, United Kingdom
Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom
National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester–NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
Kearsley-Fleet L.:
Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
Schaefer M.:
German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
Al-Emadi S.:
Hamad Medical Corporation, Doha, Qatar
Sparks J.A.:
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
Hsu T.Y.-T.:
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
Patel N.J.:
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
Wise L.:
University of Southern California, Los Angeles, CA, United States
Gilbert E.:
Division of Rheumatology, Mayo Clinic, Jacksonville, FL, United States
Duarte-García A.:
Division of Rheumatology, Mayo Clinic, Rochester, MN, United States
Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
Valenzuela-Almada M.O.:
Division of Rheumatology, Mayo Clinic, Rochester, MN, United States
Ugarte-Gil M.F.:
School of Medicine, Universidad Científica del Sur, Lima, Peru
Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
Ljung L.:
Department of Public Health and Clinical Medicine and Department of Rheumatology, Umeå University, Umeå, Sweden
Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
Scirè C.A.:
Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
Carrara G.:
Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
Hachulla E.:
INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France, U1286–INFINITE–Institute for Translational Research in Inflammation, Université de Lille, Lille, France
Richez C.:
Department of Rheumatology, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeux, France
UMR-CNRS 5164, ImmunoConcEpT, Bordeaux University, Bordeaux, France
Cacoub P.:
INSERM 959, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
Thomas T.:
Département de Médecine Interne et Immunologie Clinique, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
Centre National de Références Maladies Autoimmunes systémiques rares, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
Inflammation-Immunopathology-Biotherapy Department, Sorbonne Universites, Groupe Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
Department of Rheumatology, Hôpital Nord, Centre Hospitalier Universitaire Saint-Etienne, INSERM U1059, Lyon University, Saint-Etienne, France
Santos M.J.:
Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
Instituto de Medicina Molecular, Faculdade Medicina Lisboa, University of Lisbon, Lisbon, Portugal
Bernardes M.:
Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
Rheumatology Department, Centro Hospitalar–Universitário de São João, Porto, Portugal
Hasseli R.:
Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany
Regierer A.:
German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
Schulze-Koops H.:
Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-University Munich, Munich, Germany
Müller-Ladner U.:
Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Germany
Pons-Estel G.:
Argentine Society of Rheumatology, Buenos Aires, Argentina
Tanten R.:
Hospital Francisco Lopez Lima, General Roca, Argentina
Nieto R.E.:
Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Santa Fe, Argentina
Pisoni C.N.:
Rheumatology and Immunology Section, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, Buenos Aires, Argentina
Tissera Y.S.:
Servicio de Clínica Médica, Unidad de Reumatología del Hospital Córdoba and Sanatorio Parque de Córdoba, Córdoba, Argentina
Xavier R.:
Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Lopes Marques C.D.:
Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
Pileggi G.C.S.:
Hospital São Paulo, Universidade Federal de São Paulo, Brazil
Robinson P.C.:
University of Queensland Medical School, Brisbane, QLD, Australia
Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
Machado P.M.:
University College London, University College London Hospitals NHS Foundation Trust, Northwick Park Hospital, London North-West University Healthcare NHS Trust, London, United Kingdom
Sirotich E.:
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
Canadian Arthritis Patient Alliance, Toronto, ON, Canada
Liew J.W.:
Boston University School of Medicine, Boston, MA, United States
Hausmann J.S.:
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
Boston Children's Hospital, Boston, MA, United States
Sufka P.:
HealthPartners, St Paul, MN, United States
Grainger R.:
Department of Medicine, University of Otago Wellington, Wellington, New Zealand
Bhana S.:
Pfizer, New York, NY, United States
Gore-Massy M.:
Affiliation Lupus Foundation of America, Washington, DC, United States
Wallace Z.S.:
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
Yazdany J.:
Division of Rheumatology, School of Medicine, University of California, San Francisco, CA, United States
Nieto R.:
Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Santa Fe, Argentina
Tissera Y.:
Servicio de Clínica Médica, Unidad de Reumatología del Hospital Córdoba and Sanatorio Parque de Córdoba, Córdoba, Argentina
Pisoni C.:
Rheumatology and Immunology Section, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, Buenos Aires, Argentina
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