Race/ethnicity association with COVID-19 outcomes in rheumatic disease: Data from the COVID-19 Global Rheumatology Alliance Physician Registry.

Gianfrancesco, Milena A; Leykina, Liza A; Izadi, Zara; Taylor, Tiffany; Sparks, Jeffrey A; Harrison, Carly; Trupin, Laura; Rush, Stephanie; Schmajuk, Gabriela; Katz, Patricia; Jacobsohn, Lindsay; Hsu, Tiffany Y; D'Silva, Kristin M; Serling-Boyd, Naomi; Wallwork, Rachel; Todd, Derrick J; Bhana, Suleman; Costello, Wendy; Grainger, Rebecca; Hausmann, Jonathan S; Liew, Jean W; Sirotich, Emily; Sufka, Paul; Wallace, Zachary S; Machado, Pedro M; Robinson, Philip C; Yazdany, Jinoos

OBJECTIVE Racial/ethnic minorities experience more severe outcomes of COVID-19 in the general United States (US) population. The aim of this study was to examine the association between race/ethnicity and COVID-19 hospitalization, ventilation status, and mortality in people with rheumatic disease. METHODS US patients with rheumatic disease and COVID-19 entered into the COVID-19 Global Rheumatology Alliance physician registry March 24 - August 26, 2020 were included. Race/ethnicity was defined as white, Black, Latinx, Asian and other/mixed race. Outcomes included hospitalization, requirement for ventilatory support, and death. Multivariable regression models were used to estimate odds ratios (OR) and 95% confidence intervals controlling for age, sex, smoking, rheumatic disease diagnosis, comorbidities, medications taken prior to infection, and rheumatic disease activity. RESULTS A total of 1,324 patients were included, of whom 36% were hospitalized and 6% died; 26% of hospitalized patients required mechanical ventilation. In multivariable models, Black (OR=2.74, 95% CI 1.90, 3.95), Latinx (OR=1.71, 95% CI 1.18, 2.49), and Asian (OR=2.69, 95% CI 1.16, 6.24) patients had higher odds of being hospitalized compared to white patients. Latinx patients also had three-fold increased odds of requiring ventilatory support (OR=3.25, 95% CI 1.75, 6.05). No differences in mortality based on race/ethnicity were found, though power may have been limited to detect associations. CONCLUSION Similar to findings in the general US population, racial/ethnic minorities with rheumatic disease and COVID-19 had increased odds of hospitalization and ventilatory support. These results illustrate significant health disparities related to COVID-19 in people with rheumatic diseases. The rheumatology community should proactively address the needs of patients currently experiencing inequitable health outcomes during the pandemic.