4 August 2022

Do lockdowns and masks work for our patients?

COVID-19

In what’s believed to be the first study of its kind, a COVID-19 Global Rheumatology Alliance (GRA) data analysis has combined individual-level and regional-level data to identify links between environmental and societal factors and covid outcomes in rheumatic disease patients.

The authors said that in highlighting the importance of environmental and societal policy changes in mitigating risk for severe covid outcomes, the findings “provide powerful motivation” and lay the foundation for new research and initiatives to address global disparities.

It’s estimated that country-level covid fatality rates range from 0.5% to 20% in the general population, although the reasons for such discrepancies are not fully known.

Among rheumatic disease patients, individual risk factors for poor covid outcomes have been identified, with strategies to mitigate risk applied at patient level. However, while regional variations in individual risk factors for poor covid outcomes may account for some of the global disparities in this patient group, it’s a relatively small contribution.

The aim of the current research, published in the Lancet Rheumatology, was to explore the association between country-level variations in covid-related mortality in rheumatic disease patients and environmental and societal factors.

The study included over 14,000 rheumatic disease patients with a covid diagnosis from 23 countries across four continents entered in the GRA registry – mostly from Europe and North America. Most of the patients were female (73%) and the mean age was 54. The most common diagnoses were rheumatoid arthritis, SLE and psoriatic arthritis.

The primary endpoint was covid-related fatality, with a total of 865 deaths recorded (6.2%).

The analysis controlled for individual-level demographics, rheumatic disease diagnosis and activity, medications, comorbidities and follow-up time.

Some of the key factors independently associated with higher odds of covid-related death were low country socioeconomic status (using median age as a proxy); environmental exposures, in particular air pollution; high demands on or reduced capacity of health resources; few government-imposed containment measures, such as school closures, travel restrictions, mask wearing, testing policy and contact tracing; proportion of the population aged 65 and older; and population mobility, for which visits to workplaces, supermarkets and pharmacies were proxy.

Conversely, higher human development index, number of hospital beds and strictness of government response were associated with fewer deaths.

Strengths of the study include the large and widespread study population, while limitations include the potential of reporting bias.

“Our findings consolidate the need for policy changes that ensure equitable access to COVID-19 testing, treatment, and effective vaccination or pre-exposure prophylaxis in patients at high risk; timely and effective government response on face coverings, closures, travel controls, and restrictions on public gatherings; policies on air pollution and clean energy production; and action to alleviate global poverty,” the authors wrote.

Lancet Rheumatol 2022, online 25 July