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Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study

BACKGROUND: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortalit...

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Autores principales: Izadi, Zara, Gianfrancesco, Milena A, Schmajuk, Gabriela, Jacobsohn, Lindsay, Katz, Patricia, Rush, Stephanie, Ja, Clairissa, Taylor, Tiffany, Shidara, Kie, Danila, Maria I, Wysham, Katherine D, Strangfeld, Anja, Mateus, Elsa F, Hyrich, Kimme L, Gossec, Laure, Carmona, Loreto, Lawson-Tovey, Saskia, Kearsley-Fleet, Lianne, Schaefer, Martin, Al-Emadi, Samar, Sparks, Jeffrey A, Hsu, Tiffany Y-T, Patel, Naomi J, Wise, Leanna, Gilbert, Emily, Duarte-García, Alí, Valenzuela-Almada, Maria O, Ugarte-Gil, Manuel F, Ljung, Lotta, Scirè, Carlo A, Carrara, Greta, Hachulla, Eric, Richez, Christophe, Cacoub, Patrice, Thomas, Thierry, Santos, Maria J, Bernardes, Miguel, Hasseli, Rebecca, Regierer, Anne, Schulze-Koops, Hendrik, Müller-Ladner, Ulf, Pons-Estel, Guillermo, Tanten, Romina, Nieto, Romina E, Pisoni, Cecilia N, Tissera, Yohana S, Xavier, Ricardo, Lopes Marques, Claudia D, Pileggi, Gecilmara C S, Robinson, Philip C, Machado, Pedro M, Sirotich, Emily, Liew, Jean W, Hausmann, Jonathan S, Sufka, Paul, Grainger, Rebecca, Bhana, Suleman, Gore-Massy, Monique, Wallace, Zachary S, Yazdany, Jinoos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313519/
https://www.ncbi.nlm.nih.gov/pubmed/35909441
http://dx.doi.org/10.1016/S2665-9913(22)00192-8
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author Izadi, Zara
Gianfrancesco, Milena A
Schmajuk, Gabriela
Jacobsohn, Lindsay
Katz, Patricia
Rush, Stephanie
Ja, Clairissa
Taylor, Tiffany
Shidara, Kie
Danila, Maria I
Wysham, Katherine D
Strangfeld, Anja
Mateus, Elsa F
Hyrich, Kimme L
Gossec, Laure
Carmona, Loreto
Lawson-Tovey, Saskia
Kearsley-Fleet, Lianne
Schaefer, Martin
Al-Emadi, Samar
Sparks, Jeffrey A
Hsu, Tiffany Y-T
Patel, Naomi J
Wise, Leanna
Gilbert, Emily
Duarte-García, Alí
Valenzuela-Almada, Maria O
Ugarte-Gil, Manuel F
Ljung, Lotta
Scirè, Carlo A
Carrara, Greta
Hachulla, Eric
Richez, Christophe
Cacoub, Patrice
Thomas, Thierry
Santos, Maria J
Bernardes, Miguel
Hasseli, Rebecca
Regierer, Anne
Schulze-Koops, Hendrik
Müller-Ladner, Ulf
Pons-Estel, Guillermo
Tanten, Romina
Nieto, Romina E
Pisoni, Cecilia N
Tissera, Yohana S
Xavier, Ricardo
Lopes Marques, Claudia D
Pileggi, Gecilmara C S
Robinson, Philip C
Machado, Pedro M
Sirotich, Emily
Liew, Jean W
Hausmann, Jonathan S
Sufka, Paul
Grainger, Rebecca
Bhana, Suleman
Gore-Massy, Monique
Wallace, Zachary S
Yazdany, Jinoos
author_facet Izadi, Zara
Gianfrancesco, Milena A
Schmajuk, Gabriela
Jacobsohn, Lindsay
Katz, Patricia
Rush, Stephanie
Ja, Clairissa
Taylor, Tiffany
Shidara, Kie
Danila, Maria I
Wysham, Katherine D
Strangfeld, Anja
Mateus, Elsa F
Hyrich, Kimme L
Gossec, Laure
Carmona, Loreto
Lawson-Tovey, Saskia
Kearsley-Fleet, Lianne
Schaefer, Martin
Al-Emadi, Samar
Sparks, Jeffrey A
Hsu, Tiffany Y-T
Patel, Naomi J
Wise, Leanna
Gilbert, Emily
Duarte-García, Alí
Valenzuela-Almada, Maria O
Ugarte-Gil, Manuel F
Ljung, Lotta
Scirè, Carlo A
Carrara, Greta
Hachulla, Eric
Richez, Christophe
Cacoub, Patrice
Thomas, Thierry
Santos, Maria J
Bernardes, Miguel
Hasseli, Rebecca
Regierer, Anne
Schulze-Koops, Hendrik
Müller-Ladner, Ulf
Pons-Estel, Guillermo
Tanten, Romina
Nieto, Romina E
Pisoni, Cecilia N
Tissera, Yohana S
Xavier, Ricardo
Lopes Marques, Claudia D
Pileggi, Gecilmara C S
Robinson, Philip C
Machado, Pedro M
Sirotich, Emily
Liew, Jean W
Hausmann, Jonathan S
Sufka, Paul
Grainger, Rebecca
Bhana, Suleman
Gore-Massy, Monique
Wallace, Zachary S
Yazdany, Jinoos
author_sort Izadi, Zara
collection PubMed
description BACKGROUND: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. METHODS: In this observational study, we derived individual-level data on adults (aged 18–99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. FINDINGS: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m(3) [95% CI 1·01–1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10–1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02–1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00–1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88–1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44–0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74–0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69–0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1–9·5]; p=0·14). INTERPRETATION: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities. FUNDING: American College of Rheumatology and European Alliance of Associations for Rheumatology.
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spelling pubmed-93135192022-07-26 Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study Izadi, Zara Gianfrancesco, Milena A Schmajuk, Gabriela Jacobsohn, Lindsay Katz, Patricia Rush, Stephanie Ja, Clairissa Taylor, Tiffany Shidara, Kie Danila, Maria I Wysham, Katherine D Strangfeld, Anja Mateus, Elsa F Hyrich, Kimme L Gossec, Laure Carmona, Loreto Lawson-Tovey, Saskia Kearsley-Fleet, Lianne Schaefer, Martin Al-Emadi, Samar Sparks, Jeffrey A Hsu, Tiffany Y-T Patel, Naomi J Wise, Leanna Gilbert, Emily Duarte-García, Alí Valenzuela-Almada, Maria O Ugarte-Gil, Manuel F Ljung, Lotta Scirè, Carlo A Carrara, Greta Hachulla, Eric Richez, Christophe Cacoub, Patrice Thomas, Thierry Santos, Maria J Bernardes, Miguel Hasseli, Rebecca Regierer, Anne Schulze-Koops, Hendrik Müller-Ladner, Ulf Pons-Estel, Guillermo Tanten, Romina Nieto, Romina E Pisoni, Cecilia N Tissera, Yohana S Xavier, Ricardo Lopes Marques, Claudia D Pileggi, Gecilmara C S Robinson, Philip C Machado, Pedro M Sirotich, Emily Liew, Jean W Hausmann, Jonathan S Sufka, Paul Grainger, Rebecca Bhana, Suleman Gore-Massy, Monique Wallace, Zachary S Yazdany, Jinoos Lancet Rheumatol Articles BACKGROUND: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. METHODS: In this observational study, we derived individual-level data on adults (aged 18–99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. FINDINGS: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m(3) [95% CI 1·01–1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10–1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02–1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00–1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88–1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44–0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74–0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69–0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1–9·5]; p=0·14). INTERPRETATION: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities. FUNDING: American College of Rheumatology and European Alliance of Associations for Rheumatology. Elsevier Ltd 2022-09 2022-07-25 /pmc/articles/PMC9313519/ /pubmed/35909441 http://dx.doi.org/10.1016/S2665-9913(22)00192-8 Text en Published by Elsevier Ltd. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Articles
Izadi, Zara
Gianfrancesco, Milena A
Schmajuk, Gabriela
Jacobsohn, Lindsay
Katz, Patricia
Rush, Stephanie
Ja, Clairissa
Taylor, Tiffany
Shidara, Kie
Danila, Maria I
Wysham, Katherine D
Strangfeld, Anja
Mateus, Elsa F
Hyrich, Kimme L
Gossec, Laure
Carmona, Loreto
Lawson-Tovey, Saskia
Kearsley-Fleet, Lianne
Schaefer, Martin
Al-Emadi, Samar
Sparks, Jeffrey A
Hsu, Tiffany Y-T
Patel, Naomi J
Wise, Leanna
Gilbert, Emily
Duarte-García, Alí
Valenzuela-Almada, Maria O
Ugarte-Gil, Manuel F
Ljung, Lotta
Scirè, Carlo A
Carrara, Greta
Hachulla, Eric
Richez, Christophe
Cacoub, Patrice
Thomas, Thierry
Santos, Maria J
Bernardes, Miguel
Hasseli, Rebecca
Regierer, Anne
Schulze-Koops, Hendrik
Müller-Ladner, Ulf
Pons-Estel, Guillermo
Tanten, Romina
Nieto, Romina E
Pisoni, Cecilia N
Tissera, Yohana S
Xavier, Ricardo
Lopes Marques, Claudia D
Pileggi, Gecilmara C S
Robinson, Philip C
Machado, Pedro M
Sirotich, Emily
Liew, Jean W
Hausmann, Jonathan S
Sufka, Paul
Grainger, Rebecca
Bhana, Suleman
Gore-Massy, Monique
Wallace, Zachary S
Yazdany, Jinoos
Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
title Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
title_full Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
title_fullStr Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
title_full_unstemmed Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
title_short Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study
title_sort environmental and societal factors associated with covid-19-related death in people with rheumatic disease: an observational study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313519/
https://www.ncbi.nlm.nih.gov/pubmed/35909441
http://dx.doi.org/10.1016/S2665-9913(22)00192-8
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