(113) Racial Disparities in COVID-19 Outcomes Among Patients with Rheumatic Arthritis (RA) – a Population Based Study Using US EHR Data

Publication Number: 444

Background: Patients with chronic rheumatic diseases treated with immunomodulatory therapies may be at higher risk for more severe COVID 19 outcomes including hospitalization, complications, and death. There is lack of research on if racial disparities exist in RA patients with COVID-19 in US.

Objectives: To describe the demographic and clinical characteristics of RA patients with COVID 19 and estimate the risk of COVID 19 outcomes across race groups

Methods: A retrospective cohort study was conducted using US Optum COVID-19 electronic health record data (01/2007–06/2021). Adult RA patients with a COVID-19 diagnosis (≥ 1 diagnosis code or positive SARS-CoV-2 laboratory test) and ≥183 days of database enrollment and treated with immunomodulatory therapies prior to the diagnosis date were stratified into 4 racial groups: White, African American (AA), Asian, and Others/Unknown. Baseline (BL) demographics (age, sex, region, insurance) and clinical characteristics were evaluated. Logistic regression was used to estimate the risk of 11 COVID 19 outcomes within 30 days of the diagnosis, adjusting for demographics and demographics plus BL clinical covariates.

Results: A total of 4,476 COVID 19 patients with RA, comprising of 15% AA, 72% White, 2% Asian, and 10% Other/Unknown patients, were identified during 2020-06/2021. Compared with White patients, AAs were younger (59 vs. 62 years), more likely female (86 vs. 76 %), enrolled in Medicaid (14.5 vs. 6.5%), with more BL comorbidities/medications (e.g. hypertension: 61 vs. 46%; diabetes: 29 vs. 19%; CKD/Dialysis: 20 vs. 16%; lung disease 28 vs. 25%; corticosteroid: 36 vs. 34%). The adjusted ORs for the comparison were: Hospitalization 1.56 [95% CI 1.28, 1.91]; ICU admission 1.58 [1.11, 2.45]); Pneumonia 1.41 [1.14, 1.74]; Kidney failure 2.36 [1.81, 3.09]; Heart failure 1.55 [1.15, 2.09]; ARDS 1.26 [1.00, 1.59]; Thrombotic events 1.45 [1.03, 2.06]; Sepsis 1.49 [1.08, 2.05]; Mechanical ventilation/ECMO 1.52 [0.99, 2.35]; in hospital death 1.27 [0.86, 1.89]; and all-cause mortality 1.03 [0.72, 1.48]. Asian and Other/Unknown patients had similar demographic profile as AAs though BL clinical characteristics were similar to White patients. Compared with White patients, Asian patients had similar risk for all 11 outcomes while the risk was elevated for hospitalization, ICU admission, Pneumonia, ARDS, and Sepsis in the Other/Unknown group.

Conclusions: AA COVID 19 patients with RA had more baseline comorbidities and increased risk of COVID 19 outcomes than White patients. Our results add real-world evidence to the scarce literature on racial disparities in COVID 19 outcomes among patients with RA in the US.