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Research ArticleAccepted Article
Open Access

COVID-19 hospitalizations, intensive care unit stays, ventilation and death among patients with immune mediated inflammatory diseases compared to controls

Lihi Eder, Ruth Croxford, Aaron M. Drucker, Arielle Mendel, Bindee Kuriya, Zahi Touma, Sindhu R. Johnson, Richard Cook, Sasha Bernatsky, Nigil Haroon and Jessica Widdifield
The Journal of Rheumatology February 2022, jrheum.211012; DOI: https://doi.org/10.3899/jrheum.211012
Lihi Eder
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Ruth Croxford
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Aaron M. Drucker
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Arielle Mendel
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Bindee Kuriya
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Zahi Touma
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Sindhu R. Johnson
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Richard Cook
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Sasha Bernatsky
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Nigil Haroon
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Jessica Widdifield
Women's College Research Institute, University of Toronto, Toronto, ON, Canada; ICES, University of Toronto, Toronto, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Sinai Health System, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada; Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, ICES, Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada. Corresponding author: Dr Lihi Eder, Women's College Research Institute, Rm 6326, 76 Grenville Street, Toronto, ON, M5S 1B2. lihi.eder@wchospital.ca
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Abstract

Objective To investigate COVID-19 hospitalization risk in patients with immune mediated inflammatory diseases (IMIDs) compared with matched non-IMID comparators from the general population.

Methods We conducted a population-based, matched cohort study using health administrative data from January to July 2020 in Ontario, Canada. Cohorts for each of the following IMIDs were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PsA), ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica and vasculitis. Each patient was matched with 5 non-IMID comparators based on socio-demographic factors. We compared the cumulative incidence of hospitalizations for COVID-19 and their outcomes between IMID and non-IMID patients.

Results A total of 493,499 IMID patients (417 hospitalizations) and 2,466,946 non-IMID comparators (1,519 hospitalizations) were assessed. The odds of being hospitalized for COVID- 19 was significantly higher in patients with IMIDs compared with their matched non-IMID comparators (matched unadjusted Odds Ratio (OR) 1.37, adjusted OR 1.23). Significantly higher risk of hospitalizations was found in patients with iritis (OR 1.46), MS (OR 1.83), PsA (OR 2.20), RA (OR 1.42), SARDs (OR 1.47) and vasculitis (OR 2.07). COVID-19 hospitalizations were associated with older age, male sex, long-term care residence, multimorbidity, and lower income. The odds of complicated hospitalizations was 21% higher among all IMID versus matched non-IMID patients, but this association was attenuated after adjusting for demographic factors and comorbidities.

Conclusion Patients with IMIDs were at higher risk of being hospitalized with COVID-19. This risk was explained in part by their comorbidities.

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The Journal of Rheumatology
Vol. 49, Issue 7
1 Jul 2022
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Accepted manuscript
COVID-19 hospitalizations, intensive care unit stays, ventilation and death among patients with immune mediated inflammatory diseases compared to controls
Lihi Eder, Ruth Croxford, Aaron M. Drucker, Arielle Mendel, Bindee Kuriya, Zahi Touma, Sindhu R. Johnson, Richard Cook, Sasha Bernatsky, Nigil Haroon, Jessica Widdifield
The Journal of Rheumatology Feb 2022, jrheum.211012; DOI: 10.3899/jrheum.211012

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Accepted manuscript
COVID-19 hospitalizations, intensive care unit stays, ventilation and death among patients with immune mediated inflammatory diseases compared to controls
Lihi Eder, Ruth Croxford, Aaron M. Drucker, Arielle Mendel, Bindee Kuriya, Zahi Touma, Sindhu R. Johnson, Richard Cook, Sasha Bernatsky, Nigil Haroon, Jessica Widdifield
The Journal of Rheumatology Feb 2022, jrheum.211012; DOI: 10.3899/jrheum.211012
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