Anzalone A Jerrod, Jackson Lesley E, Singh Namrata, Danila Maria I, Reisher Elizabeth, Patel Rena C, Singh Jasvinder A
University of Nebraska Medical Center, Omaha.
University of Alabama at Birmingham.
Arthritis Care Res (Hoboken). 2025 Jan;77(1):143-155. doi: 10.1002/acr.25421. Epub 2024 Oct 16.
Autoimmune or inflammatory rheumatic diseases (AIRDs) increase the risk for poor COVID-19 outcomes. Although rurality is associated with higher post-COVID-19 mortality in the general population, whether rurality elevates this risk among people with AIRD is unknown. We assessed associations between rurality and post-COVID-19 all-cause mortality, up to two years post infection, among people with AIRD using a large nationally sampled US cohort.
This retrospective study used the National COVID Cohort Collaborative, a medical records repository containing COVID-19 patient data. We included adults with two or more AIRD diagnostic codes and a COVID-19 diagnosis documented between April 2020 and March 2023. Rural residency was categorized using patient residential zip codes. We adjusted for AIRD medications and glucocorticoid prescription, age, sex, race and ethnicity, tobacco or substance use, comorbid burden, and SARS-CoV-2 variant-dominant periods. Multivariable Cox proportional hazards with inverse probability treatment weighting assessed associations between rurality and two-year all-cause mortality.
Among the 86,467 SARS-CoV-2-infected persons with AIRD, we observed a higher risk for two-year post-COVID-19 mortality in rural versus urban dwellers. Rural-residing persons with AIRD had higher two-year all-cause mortality risk (adjusted hazard ratio 1.24, 95% confidence interval 1.19-1.29). Glucocorticoid, immunosuppressive, and rituximab prescriptions were associated with a higher risk for two-year post-COVID-19 mortality, whereas risk with nonbiologic or biologic disease-modifying antirheumatic drugs was lower.
Rural residence in people with AIRD was independently associated with higher two-year post-COVID-19 mortality in a large US cohort after adjusting for background risk factors. Policymakers and health care providers should consider these findings when designing interventions to improve outcomes in people with AIRD following SARS-CoV-2 infection, especially among high-risk rural residents.
自身免疫性或炎性风湿性疾病（AIRDs）会增加COVID-19预后不良的风险。虽然在普通人群中，农村地区与COVID-19后较高的死亡率相关，但农村地区是否会增加AIRD患者的这种风险尚不清楚。我们使用一个大型的美国全国抽样队列，评估了农村地区与AIRD患者感染COVID-19后长达两年的全因死亡率之间的关联。
这项回顾性研究使用了国家COVID队列协作项目，这是一个包含COVID-19患者数据的医疗记录库。我们纳入了在2020年4月至2023年3月期间有两个或更多AIRD诊断代码且有COVID-19诊断记录的成年人。根据患者居住的邮政编码对农村居住情况进行分类。我们对AIRD药物和糖皮质激素处方、年龄、性别、种族和民族、烟草或物质使用、合并症负担以及SARS-CoV-2变异主导期进行了调整。采用逆概率治疗加权的多变量Cox比例风险模型评估农村地区与两年全因死亡率之间的关联。
在86467名感染SARS-CoV-2的AIRD患者中，我们观察到农村居民在感染COVID-19后两年的死亡风险高于城市居民。居住在农村的AIRD患者有更高的两年全因死亡风险（调整后的风险比为1.24，95%置信区间为1.19-1.29）。糖皮质激素、免疫抑制剂和利妥昔单抗处方与感染COVID-19后两年的死亡风险较高相关，而非生物性或生物性改善病情抗风湿药物的风险较低。
在调整背景风险因素后，美国一个大型队列中，AIRD患者的农村居住情况与感染COVID-19后两年较高的死亡率独立相关。政策制定者和医疗保健提供者在设计干预措施以改善SARS-CoV-2感染后AIRD患者的预后时，应考虑这些发现，尤其是在高危农村居民中。
