Rare autoimmune rheumatic diseases increase risk of dying during COVID-19 pandemic at a younger age: Study
The researchers also found that women with rare autoimmune rheumatological diseases (RAIRD) had a greater increase in all-cause mortality rates during the pandemic when compared to men with RAIRD
Since the beginning of the COVID-19 pandemic, researchers and healthcare professionals across the world have asked people with underlying diseases to be extra cautious of the infection. People with hypertension, diabetes, lung diseases, heart diseases and even kidney diseases are considered to fall in the high-risk group, meaning they are more likely to have severe disease and complications. Additionally, there’s the need to analyse how the pandemic affects the mortality and well-being of people with diseases like cancer and HIV/AIDS since these populations need more concerted medical attention.
Rare diseases and the COVID-19 pandemic
What has, so far, been barely understood is how the COVID-19 pandemic has affected people living with rare diseases. A study published in December 2020 in the European Journal of Medical Genetics points out that more data and studies on patients living with rare diseases are needed urgently for two reasons. First, the closure or emergency restructuring of public healthcare services affects both the patients and their caregivers during the pandemic. Second, the perceived risk of infection and its associated mortality risks are likely to affect people with different subsets of rare diseases very differently.
Understanding the needs of these communities and reducing COVID-19 transmission, COVID-19 mortality and all-cause mortality risks for this population are therefore necessary targets. A recently published study in the journal Rheumatology throws some light on how the pandemic has affected the all-cause mortality risks of patients living with rare autoimmune rheumatological diseases (RAIRD) in the UK. The RAIRD population contains people living with diseases like lupus, scleroderma, myositis, primary Sjogren’s syndrome and system vasculitis conditions like Behcet’s disease.
RAIRD and increased risks of mortality
Conducted by researchers at the University of Nottingham, this study focuses on the fact that though people with RAIRD have a slightly increased mortality rate than the general population — and the fact that this mortality rate is likely to go up, both due to COVID-19 infection and associated disruptions in healthcare services — their all-cause mortality risks during the pandemic has not been quantified. The researchers, therefore, used national health records of the RAIRD population from the Hospital Episode Statistics for England and NHS Personal Demographics Service from 2003 onwards to particularly estimate the changes in their death risks before and during the pandemic.
The study included 168,691 people with a recorded diagnosis of RAIRD who were also alive at the start of the pandemic. Around 70.2percent of this population — 118,379 patients — were female, supporting the evidence that women tend to suffer more from autoimmunity. The researchers found that between March and April 2020, 1,815 or 1.1 percent of people with RAIRD died — a rate which was 1.44 times higher than the average mortality rate of this population during the same months in the previous five years. The mortality rate of the general population during the same time period in 2020 was 1.38 times higher. While this difference in mortality rates may not seem much, it’s significant that the mortality risk among people with RAIRD shot up in those aged 35 years and above, while the same mortality risks among the general population began from the age of 55 years or above.
So, in effect, if you have RAIRD, your risk of all-cause mortality during the COVID-19 pandemic is equal to the risk of someone 20 years older in the general population. If this increased risk of death at a younger age isn’t alarming enough, the researchers also found that women with RAIRD had a greater increase in all-cause mortality rates during the pandemic when compared to men with RAIRD. The researchers concluded that further studies are urgently needed to reveal how many people with RAIRD are dying directly due to COVID-19 and how the effect of ethnicity, immunosuppression and steroid usage is shaping their mortality risks during the pandemic too. Analysing these parameters can better quantify the risks associated with COVID-19 infection and those due to disrupted healthcare services so that better shielding advice can be provided to people with RAIRD.
For more information, read our article on Autoimmune diseases.
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