Increased Mortality Risk Among Patients With Rare Autoimmune Rheumatic Diseases During the COVID-19 Pandemic

hospital patient
Researchers quantified the risk for death among patients with rare autoimmune rheumatic diseases vs the general population during the COVID-19 pandemic.

Risk for all-cause death among patients with rare autoimmune rheumatic diseases (RAIRD) vs the general population was found to be significantly elevated during the coronavirus disease 2019 (COVID-19) pandemic compared to the prepandemic period, according to study results published in Rheumatology.

Researchers extracted data from the Hospital Episode Statistics (HES) dataset, which included information on inpatient hospital visits at facilities around England. Patients were eligible for inclusion in the study if they had an inpatient visit registered in HES with a diagnostic code for a RAIRD. Clinical data were linked to sociodemographic information using the National Health Service Personal Demographics Service. The primary study outcome was age-standardized mortality rate (ASMR) of patients with RAIRD between March and April 2020. Mortality rate calculations were repeated for the March to April period of the previous 5 years. The ASMRs of the general population during the same time periods were calculated using data from the Office for National Statistics.

The study cohort included 168,691 patients with RAIRD diagnoses who were alive on March 1, 2020. The majority of patients were women (70.2%). The most common RAIRD diagnoses were giant cell arteritis (22.1%), systemic lupus erythematosus (21.6%), and juvenile inflammatory arthritis (12.5%). Median age on March 1, 2020 was 61.7 years. During the study period, a total of 1815 patients (1.1%) with RAIRD died from any cause; age-standardized mortality rate was 3669.3 (95% CI, 3500.4-3838.1) per 100,000 person-years, which was 1.44 (95% CI, 1.42-1.45) times greater than the mean ASMR during the same months of the previous 5 years. Among the general population of England, the ASMR increased 1.38 times during the pandemic months. Overall, patients with RAIRD vs the general population experienced a more significant change in mortality during the pandemic.

In addition, the researchers observed that mortality rates increased during the pandemic for patients with RAIRDs who were aged 35 years or more vs individuals in the general population who were aged 55 years or more. Women vs men with RAIRDs also experienced a greater increase in mortality rates; however, in the general population, mortality increased more significantly among men.

While data on cause-specific mortality were not recorded in the study, the evidence strongly suggests that the pandemic has an effect on risk for death in patients with RAIRDs. Researchers hypothesized that in addition to COVID-19 infection, disruptions in health care services may have driven increases in mortality.

“Further research is urgently needed on the causes of death to understand how many people are dying of COVID-19 and how many due to other causes, as well as the effect of ethnicity, immunosuppression and steroid usage on risks for people with RAIRD,” the researchers wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Peach E, Rutter M, Lanyon P, et al. Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic. Rheumatology (Oxford). Published online December 4, 2020. doi:10.1093/rheumatology/keaa855