Gout increases the risk of COVID-19-related death in women
Gout increases the risk of COVID-19-related death in women

Gout increases the risk of COVID-19-related death in women

Data from a UK biobank cohort suggest that arthritis is not only a risk factor for COVID-19-related death, but that the risk increases in women with arthritis, independent of metabolic comorbidities, according to a study published in The Lancet.1

The UK Biobank, which contains 500,000 volunteers aged 49-86 years, included data from 15,871 patients with arthritis. COVID-19 diagnoses were defined as those with a positive SARS-CoV-2 test or ICD-10 code for confirmed or probable COVID-19. Arthritis was determined by self-reported arthritis, hospital-diagnosed arthritis, and those receiving allopurinol or sulfinpyrazone.

Multivariate-adjusted logistic regression was used to assess coherence in 4 case-controlled data sets. Analysis A determined any association between arthritis and COVID-19 diagnosis in a population-based cohort (16,898 patients and 442,939 controls); analysis B determined any association between arthritis and COVID-19-related deaths in participants diagnosed with COVID-19; analysis C focused on associations between arthritis and COVID-19-related deaths in a population-based group; and assay D tested for any coherence within the UK Biobank subgroup with data on colchicine and urate-lowering prescriptions and the risk of COVID-19-related death in patients with arthritis.

Models 1 and 2 adjusted for age, ethnicity, BMI, gender, smoking status, and Townsend deprivation index, with Model 2 also adjusting for 16 additional comorbidities of arthritis and risk factors for COVID-19 deaths.

Of the 459,837 participants included in the population-based cohort, 15,871 were diagnosed with arthritis. Between March 2020 and March 2021, 0.9% of patients with arthritis died due to COVID-19 compared to only 0.2% of the controls. In addition, patients who died had a higher percentage of metabolic-based diseases, such as chronic kidney disease (19.1%) and diabetes (30.7%) compared with controls (3.2% and 7.3%, respectively).

Arthritis was associated with COVID-19-related death throughout the cohort (1.29, 1.06–1.56), with women experiencing an increased risk (1.98, 1.34–2.94) compared with men ( 1.16, 0.93-1.45) (1.3% vs. 0.8%, respectively). In addition, women with arthritis had a higher number of comorbidities than men, while men had a higher number throughout the cohort.

No significant differences were seen in the risk of COVID-19-related death with respect to antidepressant treatment or colchicine treatment.

The COVID-19 diagnosis was significantly higher in patients who were not vaccinated (1.21, 1.11-1.30) compared to the vaccinated cohort (1.09, 0.65-1.85).

Data may not be generalizable as most patients were middle-aged white British patients from the United Kingdom. Unidentified COVID-19-related deaths are also possible. Another limitation is that before August 2020, Public Health England had listed the cause of death as COVID-19 if patients had ever received a positive test result, so some of these deaths are inevitably unrelated to COVID-19. However, the organization estimates 96% accuracy. In addition, disease activity, individual behavior change, and medication adherence were not assessed.

“We found an increased risk of COVID-19-related death in people with arthritis, with a greater burden in women than men,” investigators concluded. “Understanding the causes of this increased risk in women with arthritis requires further study in larger datasets.”

Reference:

Topless RK, Gaffo A, Stamp LK, Robinson PC, Dalbeth N, Merriman TR. Arthritis and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study. Lancet Rheumatol. 2022; 4 (4): e274-e281. doi: 10.1016 / S2665-9913 (21) 00401-X

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