TY - JOUR
T1 - Long-Term Mortality Following SARS-CoV-2 Infection in Rural Versus Urban Dwellers With Autoimmune or Inflammatory Rheumatic Disease
T2 - A Retrospective Cohort Analysis From the National COVID Cohort Collaborative
AU - the National COVID Cohort Collaborative Consortium
AU - Anzalone, A. Jerrod
AU - Jackson, Lesley E.
AU - Singh, Namrata
AU - Danila, Maria I.
AU - Reisher, Elizabeth
AU - Patel, Rena C.
AU - Singh, Jasvinder A.
AU - Wilcox, Adam B.
AU - Lee, Adam M.
AU - Graves, Alexis
AU - Anzalone, Alfred
AU - Manna, Amin
AU - Saha, Amit
AU - Olex, Amy
AU - Zhou, Andrea
AU - Williams, Andrew E.
AU - Southerland, Andrew
AU - Girvin, Andrew T.
AU - Walden, Anita
AU - Sharathkumar, Anjali A.
AU - Amor, Benjamin
AU - Bates, Benjamin
AU - Hendricks, Brian
AU - Patel, Brijesh
AU - Alexander, Caleb
AU - Bramante, Carolyn
AU - Ward-Caviness, Cavin
AU - Madlock-Brown, Charisse
AU - Suver, Christine
AU - Chute, Christopher
AU - Dillon, Christopher
AU - Wu, Chunlei
AU - Schmitt, Clare
AU - Takemoto, Cliff
AU - Housman, Dan
AU - Gabriel, Davera
AU - Eichmann, David A.
AU - Mazzotti, Diego
AU - Brown, Don
AU - Boudreau, Eilis
AU - Hill, Elaine
AU - Zampino, Elizabeth
AU - Marti, Emily Carlson
AU - Pfaff, Emily R.
AU - French, Evan
AU - Koraishy, Farrukh M.
AU - Mariona, Federico
AU - Prior, Fred
AU - Sokos, George
AU - Martin, Greg
AU - Lehmann, Harold
AU - Spratt, Heidi
AU - Mehta, Hemalkumar
AU - Liu, Hongfang
AU - Sidky, Hythem
AU - Hayanga, J. W.Awori
AU - Pincavitch, Jami
AU - Clark, Jaylyn
AU - Harper, Jeremy Richard
AU - Islam, Jessica
AU - Ge, Jin
AU - Gagnier, Joel
AU - Saltz, Joel H.
AU - Saltz, Joel
AU - Loomba, Johanna
AU - Buse, John
AU - Mathew, Jomol
AU - Rutter, Joni L.
AU - McMurry, Julie A.
AU - Guinney, Justin
AU - Starren, Justin
AU - Crowley, Karen
AU - Bradwell, Katie Rebecca
AU - Walters, Kellie M.
AU - Wilkins, Ken
AU - Gersing, Kenneth R.
AU - Cato, Kenrick Dwain
AU - Murray, Kimberly
AU - Kostka, Kristin
AU - Northington, Lavance
AU - Pyles, Lee Allan
AU - Misquitta, Leonie
AU - Cottrell, Lesley
AU - Portilla, Lili
AU - Deacy, Mariam
AU - Bissell, Mark M.
AU - Clark, Marshall
AU - Emmett, Mary
AU - Saltz, Mary Morrison
AU - Palchuk, Matvey B.
AU - Haendel, Melissa A.
AU - Adams, Meredith
AU - Temple-O'Connor, Meredith
AU - Kurilla, Michael G.
AU - Morris, Michele
AU - Qureshi, Nabeel
AU - Safdar, Nasia
AU - Garbarini, Nicole
AU - Sharafeldin, Noha
AU - Sadan, Ofer
AU - Francis, Patricia A.
AU - Burgoon, Penny Wung
AU - Robinson, Peter
AU - Payne, Philip R.O.
AU - Fuentes, Rafael
AU - Jawa, Randeep
AU - Erwin-Cohen, Rebecca
AU - Patel, Rena
AU - Moffitt, Richard A.
AU - Zhu, Richard L.
AU - Kamaleswaran, Rishi
AU - Hurley, Robert
AU - Miller, Robert T.
AU - Pyarajan, Saiju
AU - Michael, Sam G.
AU - Bozzette, Samuel
AU - Mallipattu, Sandeep
AU - Vedula, Satyanarayana
AU - Chapman, Scott
AU - O'Neil, Shawn T.
AU - Setoguchi, Soko
AU - Hong, Stephanie S.
AU - Johnson, Steve
AU - Bennett, Tellen D.
AU - Callahan, Tiffany
AU - Topaloglu, Umit
AU - Sheikh, Usman
AU - Gordon, Valery
AU - Subbian, Vignesh
AU - Kibbe, Warren A.
AU - Hernandez, Wenndy
AU - Beasley, Will
AU - Cooper, Will
AU - Hillegass, William
AU - Zhang, Xiaohan Tanner
N1 - Publisher Copyright:
Published 2024. This article is a U.S. Government work and is in the public domain in the USA.
PY - 2025/1
Y1 - 2025/1
N2 - Objective: 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. Methods: 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. Results: 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. Conclusion: 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. (Figure presented.).
AB - Objective: 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. Methods: 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. Results: 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. Conclusion: 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. (Figure presented.).
UR - http://www.scopus.com/inward/record.url?scp=85206456336&partnerID=8YFLogxK
U2 - 10.1002/acr.25421
DO - 10.1002/acr.25421
M3 - Article
C2 - 39158165
AN - SCOPUS:85206456336
SN - 2151-464X
VL - 77
SP - 143
EP - 155
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 1
ER -