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Risk of COVID‐19 Among Unvaccinated and Vaccinated Patients With Rheumatoid Arthritis: A General Population Study
Author(s) -
Li Hui,
Wallace Zachary S.,
Sparks Jeffrey A.,
Lu Na,
Wei Jie,
Xie Dongxing,
Wang Yilun,
Zeng Chao,
Lei Guanghua,
Zhang Yuqing
Publication year - 2023
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.25028
Subject(s) - medicine , hazard ratio , rheumatoid arthritis , confidence interval , population , vaccination , incidence (geometry) , cohort , cohort study , immunology , physics , environmental health , optics
Objective To determine whether patients with rheumatoid arthritis (RA) are at higher risks for SARS–CoV‐2 infection and its severe outcomes before and after COVID‐19 vaccination. Methods Using a UK primary care database, we conducted 2 cohort studies to compare the risks of SARS–CoV‐2 infection, hospitalization, and death from COVID‐19 between patients with RA and the general population according to their COVID‐19 vaccination status. We used exposure score overlap weighting to balance baseline characteristics between 2 comparison cohorts. Results Among unvaccinated individuals, the weighted incidence rates of SARS–CoV‐2 infection (9.21 versus 8.16 of 1,000 person‐months), hospitalization (3.46 versus 2.14 of 1,000 person‐months), and death (1.19 versus 0.62 of 1,000 person‐months) were higher among patients with RA than the general population over 3 months of follow‐up; the corresponding adjusted hazard ratios (HRs) were 1.10 (95% confidence interval [95% CI] 1.00–1.24), 1.62 (95% CI 1.34–1.96), and 1.88 (95% CI 1.37–2.60), respectively. Among vaccinated individuals, the weighted rates of breakthrough infection (4.17 versus 3.96 of 1,000 person‐months; HR 1.10 [95% CI 1.00–1.20]) and hospitalization (0.42 versus 0.32 of 1,000 person‐months; HR 1.29 [95% CI 0.96–1.75]) were higher among patients with RA than the general population over 9 months of follow‐up; however, no apparent difference in the risk of these outcomes was observed over 3 and 6 months of follow‐up between 2 comparison cohorts. Conclusion Patients with RA are still at higher risks of SARS–CoV‐2 infection and COVID‐19 hospitalization than the general population after receiving COVID‐19 vaccines. These findings support booster COVID‐19 vaccinations and adherence of other preventive strategies among patients with RA.