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.”
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