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. 2023 Feb:56:101783.
doi: 10.1016/j.eclinm.2022.101783. Epub 2023 Jan 10.

Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study

Renin Chang  1   2   3 , Thomas Yen-Ting Chen  4   5 , Shiow-Ing Wang  3   6 , Yao-Min Hung  7   8   9 , Hui-Yuan Chen  3 , Cheng-Chung James Wei  3   10   11   12
Affiliations

Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study

Renin Chang et al. EClinicalMedicine. 2023 Feb.

Abstract

Background: There are a growing number of case reports of various autoimmune diseases occurring after COVID-19, yet there is no large-scale population-based evidence to support this potential association. This study provides a closer insight into the association between COVID-19 and autoimmune diseases and reveals discrepancies across sex, age, and race of participants.

Methods: This is a retrospective cohort study based on the TriNetX U.S. Collaborative Network. In the test-negative design, cases were participants with positive polymerase chain reaction (PCR) test results for SARS-CoV-2, while controls were participants who tested negative and were not diagnosed with COVID-19 throughout the follow-up period. Patients with COVID-19 and controls were propensity score-matched (1: 1) for age, sex, race, adverse socioeconomic status, lifestyle-related variables, and comorbidities. The primary endpoint is the incidence of newly recorded autoimmune diseases. Adjusted hazard ratios (aHRs) and 95% confident intervals (CIs) of autoimmune diseases were calculated between propensity score-matched groups with the use of Cox proportional-hazards regression models.

Findings: Between January 1st, 2020 and December 31st, 2021, 3,814,479 participants were included in the study (888,463 cases and 2,926,016 controls). After matching, the COVID-19 cohort exhibited significantly higher risks of rheumatoid arthritis (aHR:2.98, 95% CI:2.78-3.20), ankylosing spondylitis (aHR:3.21, 95% CI:2.50-4.13), systemic lupus erythematosus (aHR:2.99, 95% CI:2.68-3.34), dermatopolymyositis (aHR:1.96, 95% CI:1.47-2.61), systemic sclerosis (aHR:2.58, 95% CI:2.02-3.28), Sjögren's syndrome (aHR:2.62, 95% CI:2.29-3.00), mixed connective tissue disease (aHR:3.14, 95% CI:2.26-4.36), Behçet's disease (aHR:2.32, 95% CI:1.38-3.89), polymyalgia rheumatica (aHR:2.90, 95% CI:2.36-3.57), vasculitis (aHR:1.96, 95% CI:1.74-2.20), psoriasis (aHR:2.91, 95% CI:2.67-3.17), inflammatory bowel disease (aHR:1.78, 95%CI:1.72-1.84), celiac disease (aHR:2.68, 95% CI:2.51-2.85), type 1 diabetes mellitus (aHR:2.68, 95%CI:2.51-2.85) and mortality (aHR:1.20, 95% CI:1.16-1.24).

Interpretation: COVID-19 is associated with a different degree of risk for various autoimmune diseases. Given the large sample size and relatively modest effects these findings should be replicated in an independent dataset. Further research is needed to better understand the underlying mechanisms.

Funding: Kaohsiung Veterans General Hospital (KSVGH111-113).

Keywords: Autoimmune disease; COVID-19; Cohort study; Electronic health records; SARS-CoV-2 infection.

PubMed Disclaimer

Conflict of interest statement

All authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of cohort construction.
Fig. 2
Fig. 2
Forest plot of outcomes.
Fig. 3
Fig. 3
Kaplan–Meier curves of all the autoimmune disease outcomes.
Fig. 4
Fig. 4
Forest plot of outcomes stratified by sex.
Fig. 5
Fig. 5
Forest plot of outcomes stratified by age.
Fig. 6
Fig. 6
Forest plot of outcomes stratified by race.
Fig. 7
Fig. 7
Forest plot of outcomes stratified by severity of disease.
See this image and copyright information in PMC

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