Rheumatoid arthritis and the risk of COVID-19 diagnosis, hospitalisation and death: A population-based multi-state cohort analysis including 5,586,565 people in Catalonia, Spain

Vivekanantham, A.; Burn, E.; Fernandez-Bertolin, S.; Aragon, M.; Duarte-Salles, T.; Prieto-Alhambra, D.

Background: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is of particular concern for people with rheumatoid arthritis (RA), with concerns that these people may be at higher risk and have poorer outcomes. However, at present the implications of COVID-19 for people with RA remain poorly understood. Objectives: To investigate the associations between rheumatoid arthritis and the risk of COVID-19 diagnosis, hospitalisation with COVID-19 and COVID-19-related death. Methods: A population-based cohort study including all individuals registered in the Information System for Research in Primary Care (SIDIAP). SIDIAP includes primary care records covering over 80% of the population of Catalonia, Spain, and was linked to region-wide SARS-CoV-2 PCR testing, hospital and mortality records. Outpatient diagnoses of COVID-19, hospitalisations with COVID-19 and deaths with COVID-19 were identified as study outcomes between 1st March and 6th May 2020. A multi-state model was used, with cause-specific Cox survival models estimated for each transition, adjusted for age and sex. Results: A total of 5,586,565 individuals were identified in SIDIAP as of the 1st March 2020, of which 16,344 had RA. RA patients were median (IQR) 63 years (52.0, 74.0) and the majority (n=11,727, 71.8%) were female. Having RA was positively associated with being diagnosed with COVID-19 (adjusted HR 1.14 (1.03 to 1.28)), with hospitalisation with COVID-19 (HR 1.66 (1.35 to 2.04)). However, we did not find an association between RA status and the risk of worsening from outpatient diagnosis to hospitalization or death, or from hospitalization to death (see Table 1). Conclusion: To our knowledge, this is the largest study performed to date looking at COVID-19 outcomes in RA patients. Individuals with RA were found to have an increased risk of COVID-19 diagnosis and hospitalisation with COVID-19, compared to the general population. Further research is needed to address factors associated with this including the presence of other co-morbidities, underlying RA disease activity and the use of immunosuppressive medications.