COVID-19 infection, admission and death and the impact of corticosteroids amongst people with rare autoimmune rheumatic disease during the second wave of covid-19 in England: results from the RECORDER Project

ObjectivesTo calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the second wave of the COVID-19 pandemic in England, and describe the impact of corticosteroids on outcomes.MethodsHospital Episode Statistics data were used to identify people alive 01 August 2020 with ICD-10 codes for RAIRD from the whole population of England. Linked national health records were used to calculate rates and rate ratios of COVID-19 infection and death up to 30 April 2021. Primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. NHS Digital and Office for National Statistics general population data were used for comparison. The association between 30-day corticosteroid usage and COVID-19-related death, COVID-19-related hospital admissions and all-cause deaths were also described.ResultsOf 168 330 people with RAIRD, 9,961 (5.92%) had a positive COVID-19 PCR test. The age-standardised infection rate ratio between RAIRD and the general population was 0.99 (95% CI 0.97–1.00). 1,342 (0.80%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardised mortality rate for COVID-19-related death was 2.76 (2.63–2.89) times higher than in the general population. There was a dose-dependent relationship between 30-day corticosteroid usage and COVID-19-related death. There was no increase in deaths due to other causes.ConclusionsDuring the second wave of COVID-19 in England, people with RAIRD had the same risk of COVID-19 infection but a 2.76-fold increased risk of COVID-19-related death compared with the general population, with corticosteroids associated with increased risk