Infectious Disease

Weight problems will increase the chance of COVID-19 in Latino sufferers with rheumatic illness

February 01, 2021

3 min read

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Disclosure:
Researchers report support from the National Institute for Arthritis and Musculoskeletal Disorders and Skin Diseases of the NIH and the National Institute for Minority Health and Health Differences.

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Latino patients with rheumatic disease have high rates of COVID-19, with obesity identified as the main risk factor for infection, which, according to the data, was linked to an increased risk of rheumatic disease flare-ups.

“Latino people have been reported to have a higher incidence and severe COVID-19 disease.” Alice Fike, MSN, of the NIH National Institute for Arthritis and Musculoskeletal Disorders (NIAMS), said Healio Rheumatology. “Interestingly, we observed an even higher incidence rate in our mostly Latin American patient group, but a mild COVID-19 illness with no associated mortality.”

“The incidence of COVID-19 in Latin patients with rheumatic disease was three times higher than that of Latinos in the general population,” Alice Fike, MSN, told Healio Rheumatology. Source: Adobe Stock

According to Fike and colleagues, Latinos living in the US not only have a higher prevalence of obesity, diabetes, and kidney disease, but also lower insurance coverage than the general population.

“Latinos are more likely to work in positions that are considered essential, which increases the risk of infection,” the researchers wrote in Arthritis & Rheumatology. “Such jobs often have limited or no sick leave, which perpetuates this increased risk for Latino workers. The combination of these factors has resulted in Latino patients being disproportionately affected by COVID-19, leading to increased incidence, disease severity, and mortality. “

Alice Fike

To analyze the clinical features and outcomes of COVID-19 in Latino patients with rheumatic diseases, Fike and colleagues conducted a retrospective study of an existing observational cohort as part of the NIAMS Intramural Research Program in Washington, DC. This cohort comprised 307 active participants with rheumatic diseases who were referred to the NIAMS clinic by state-qualified health centers.

For their own study, Fike and colleagues identified 32 cohort patients – all of their own reported Latino ethnicity – with COVID-19 during the study period from April 2020 to October 15, 2020. For the comparison group, the researchers included 146 Latino patients from the NIAMS cohort, who were seen during the study period and were asymptomatic for COVID-19 and whose exposure was denied. However, these comparator patients had not been tested for COVID-19. Fike and colleagues analyzed demographics, BMI, comorbidities, and immunomodulatory therapies for all included participants. In addition, they used an exploratory classification and regression tree (CART) and logistic regression analysis to identify risk factors for COVID-19 and rheumatic diseases.

According to the researchers, the COVID-19 incidence rate of the cohort was 17,978 per 100,000, which was three times higher than the incidence rate observed in Latino residents of 4,689 to 5,809 per 100,000 and five to eleven times higher than the rate of 1,540 to 3,431 per 100,000 for the general population – both within the local river basins during the study period. However, no patient with COVID-19 required intensive care care. All patients with COVID-19 were either classified as essential workers or lived in a household with essential workers.

Using the CART and logistic regression analyzes, the researchers found that a BMI greater than 30.35 was a risk factor for COVID-19 (OR = 3.37; 95% CI, 1.5-7.7). In addition, a COVID-19 infection was identified as a risk factor for rheumatic diseases (OR = 4.57; 95% CI, 1.2-17.4).

“The incidence of COVID-19 in Latino patients with rheumatic disease was three times higher than that of Latinos in the general population,” said Fike. “In our study, there was an association between obesity and the risk of COVID-19 disease, and an association between COVID-19 disease and the subsequent onset of rheumatic disease that was not related to stopping anti-inflammatory drugs during infection.”

Pravitt Gourh

Co-author Pravitt Gourh, MD, from NIAMS and the National Institute for Minority Health and Health Differences at NIH advised providers to counsel their obese patients about their potentially increased risk.

“Latinos with rheumatic diseases are at increased risk of developing COVID-19 disease and a subsequent rheumatic disease outbreak,” said Gourh said Healio Rheumatology. “Therefore, rheumatologists should monitor patients after a COVID-19 infection and advise overweight patients that they may be at increased risk of COVID-19 disease.”

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