Identification of a Vulnerable Group for Post-Acute Sequelae of SARS-CoV-2 (PASC): People with Autoimmune Diseases Recover More Slowly from COVID-19

Figures & data

Table 1 Characteristics of COVID-19-Positive CARE Registry Participants at Enrollment by Self-Reported Use of Medications for Autoimmune Disease

	Participants at Enrollment		Participants with Follow-Up Around Day 30
	Taking Medications for Autoimmune Disease	Not Taking Medications for Autoimmune Disease	Taking Medications for Autoimmune Disease	Not Taking Medications for Autoimmune Disease
	(n=70)	(n=1,448)	(n=41)	(n=936)
Age, years
Mean (SD)	46.9 (10.5)	40.9 (11.9)	48.6 (10.3)	41.6 (11.8)
Median (IQR)	45.5 (41–54)	40 (32–49)	48 (43–4)	41 (33–50)
	n (%)	n (%)	n (%)	n (%)
Gender
Female	65 (92.9)	1257 (86.8)	39 (95.5)	817 (87.3)
Education
High school or less	3 (2.86)	229 (15.8)	1 (2.4)	139 (14.9)
Some college/2-year degree	30 (42.8)	553 (38.2)	15 (36.6)	338 (36.1)
4-year college degree	20 (28.6)	326 (22.5)	14 (34.2)	233 (24.9)
>4-year college degree	15 (21.4)	304 (21.0)	10 (24.4)	213 (22.8)
Race
Black or African American	6 (8.6)	85 (5.87)	3 (7.3)	54 (5.8)
White	58 (82.9)	1,141 (78.8)	36 (87.8)	765 (81.7)
Other	6 (8.5)	222 (5.3)	1 (2.4)	117 (12.5)
Ethnicity
Hispanic or Latino	5 (7.2)	228 (15.8)	5 (12.2)	142 (15.2)
BMI group
Normal (<25)	13 (18.6)	352 (24.3)	9 (22.0)	214 (22.9)
Overweight (25–30)	17 (24.3)	366 (25.3)	11 (26.8)	244 (26.1)
Obese (≥30)	38 (54.3)	683 (47.7)	20 (48.5)	458 (49.0)
Medical history
Smoker	1 (1.4)	13 (0.9)	0 (0.0)	88 (9.4)
Cardiovascular Disease (incl. heart disease, stroke)	5 (7.14)	52 (3.6)	3 (7.3)	36 (3.9)
Taking Medication for Diabetes	9 (12.9)	93 (6.4)	5 (12.2)	61 (6.5)
Taking Medication for Hypertension	21 (30.0)	240 (16.6)	9 (22.0)	144 (15.4)
Taking Medication for Lung Disease	10 (14.3)	87 (6.0)	5 (12.2)	62 (6.6)
Hospitalized Due to Likely COVID-19 Related	2 (2.9)	18 (1.2)	1 (2.4)	8 (0.9)
Incentivized	35 (50.0)	793 (54.8)	28 (68.3)	666 (71.2)
Distribution of Symptoms at Enrollment
N of symptoms
Mean (SD)	7.3 (3.1)	6.6 (3.3)	7.0 (3.1)	6.8 (3.2)
Median (IQR)	7 (5-9)	7 (4-9)	7 (5–9)	9 (7–11)
Severity score*
Mean (SD)	12.1 (6.4)	10.9 (6.6)	11.8 (6.4)	11.3 (6.4)
Median (IQR)	12 (7-17)	10 (6-15)	11 (7–17)	11 (6–15)

Notes: *Severity score was calculated as the sum of individual symptom severity across 15 symptoms (0=absent; 1=very mild/mild; 2=moderate; 3=severe).

Abbreviations: SD, standard deviation; IQR, interquartile range; BMI, body mass index.

Figure 1 Symptom prevalence (%) for COVID-19-positive participants by self-reported use of medication for autoimmune disease.

Notes: (A) Prevalence (%) of any symptom; taking medication for autoimmune disease at enrollment. (B) Prevalence (%) of any symptom; not taking medication for autoimmune disease at enrollment. (C) Prevalence (%) of moderate or severe symptoms; taking medication for autoimmune disease at enrollment. (D) Prevalence (%) of moderate or severe symptoms; not taking medication for autoimmune disease at enrollment. Data cut as of March 1, 2021. Sample size: taking medication for autoimmune disease: day 0: n=70; day 7: n=59;day 14: n=54; day 21: n=45; day 30: n=42. Not taking medication for autoimmune disease: day 0: n=1,448; day 7: n=1,199; day 14: n=1,043; day 21: n=945; day 30: n=951. Survey windows: 0=enrollment; 7=days 3–10; 14=days 11–17; 21=days 18–24; 30=days 25–45.

Table 2 Risk of More Severe COVID-19 Presentation and Persistent Symptoms Among Participants Reporting Use of Medications for Autoimmune Disease Compared to Those Reporting Not Taking Medications

	At Enrollment		Around Day 30 After Enrollment*
	≥7 Symptoms**	≥11 Severity** Score	≥3 Symptoms***	Shortness of Breath	Fatigue
Unadjusted OR (95% CI)
Medications for autoimmune disease	1.27 (0.75–2.13)	1.41 (0.84–2.38)	2.39 (1.27–4.47)	2.53 (1.20–5.30)	3.48 (1.83–6.62)
Adjusted* OR (95% CI)
Medications for autoimmune disease	1.17 (0.68–2.01)	1.32 (0.76–2.29)	2.53 (1.21–5.29)	2.66 (1.15–6.18)	4.73 (2.17– 10.34)
Age 30–39 vs 18–29	1.13 (0.81–1.57)	1.03 (0.74_1.43)	1.55 (0.91–2.64)	0.73 (0.36–1.49)	1.86 (1.11–3.13)
Age 40–49 vs 18–29	1.22 (0.87–1.73)	1.34 (0.95–1.89)	1.91 (1.12–3.26)	1.53 (0.79–2.98)	1.90 (1.12–3.23)
Age 50–59 vs 18–29	1.15 (0.78–1.71)	0.93 (0.63; 1.38)	1.95 (1.08–3.52)	0.74 (0.34–1.65)	3.16 (1.78–5.60)
Age 60+ vs 18–29	0.59 (0.35–0.98)	0.47 (0.28–0.79)	2.28 (1.09–4.80)	0.59 (0.20–1.76)	2.54 (1.22–5.26)
Gender other than Female	0.49 (0.34–0.70)	0.46 (0.31–0.64)	0.42 (0.22–0.80)	0.26 (0.08–0.87)	0.40 (0.22–0.74)
Race other than White	0.79 (0.59–1.06)	0.87 (0.64–1.17)	0.74 (0.46–1.18)	0.30 (0.13–0.69)	0.82 (0.53–1.29)
Ethnicity Hispanic/Latino	0.97 (0.71–1.34)	1.03 (0.75–1.41)	1.11 (0.69–1.76)	1.03 (0.53–1.98)	1.39 (0.89–2.16)
BMI overweight vs normal	1.43 (1.04–1.95)	1.31 (0.95–1.79)	1.53 (0.96–2.45)	0.81 (0.42–1.55)	1.04 (0.66–1.63)
BMI obese vs normal	1.75 (1.31–2.33)	1.99 (1.50–2.66)	1.25 (0.81–1.94)	0.82 (0.46–1.46)	1.21 (0.80–1.84)
Education high school or less vs college	2.10 (1.44–3.07)	1.65 (1.14–2.42)	0.97 (0.57–1.66)	1.67 (0.76–3.67)	1.09 (0.64–1.85)
Education some college vs college	1.73 (1.30–2.32)	1.50 (1.12–2.01)	0.94 (0.62–1.42)	2.27 (1.23–4.18)	1.10 (0.74–1.66)
Education more than college vs college	1.34 (0.97–1.86)	1.09 (0.79–1.52)	0.89 (0.56–1.41)	1.54 (0.77–3.10)	1.30 (0.84–2.03)
Smoker yes vs no	1.30 (0.89–1.90)	1.29 (0.89–1.88)	1.45 (0.84–2.50)	1.15 (0.57–2.32)	1.06 (0.61–1.83)
Cardiovascular disease	1.22 (0.65–2.29)	1.65 (0.87–3.13)	0.84 (0.37–1.90)	0.96 (0.34–2.70)	1.27 (0.58–2.80)
Taking medications for diabetes	0.85 (0.53–1.36)	0.72 (0.45–1.16)	0.72 (0.37–1.39)	0.92 (0.38–2.18)	0.75 (0.39–1.44)
Taking medications for hypertension	1.41 (0.99–1.98)	1.18 (0.83–1.66)	1.36 (0.86–2.17)	1.69 (0.92–3.11)	0.92 (0.57–1.47)
Taking medications for lung disease	1.91 (1.17–3.11)	1.80 (1.11–2.94)	1.59 (0.89–2.82)	2.31 (1.20–4.48)	1.57 (0.89–2.77)
Number of symptoms at enrollment	1.27 (0.75–2.13)	1.41 (0.8–2.38)	1.25 (1.18–1.32)	1.12 (1.04–1.21)	1.22 (1.16–1.29)

Notes: Models for endpoints evaluated at enrollment were adjusted for age, gender, race, ethnicity, BMI, smoking status, diagnosis of cardiovascular disease, use of medications for lung disease, diabetes, and hypertension; models for endpoints assessed in follow-up were additionally adjusted for the number of symptoms reported at enrollment. Highlighted in bold are ORs with 96% CI that do not include 1.00 (ie, statistically significant). *Around day 30 includes a range of 25–45 days after enrollment, with a median [IQR] time of 30 [28–42]. **Median in the overall population was used for the cutoff. ***75th percentile in the overall population was used for the cutoff.

Abbreviations: OR, odds ratios; CI, confidence interval.

Table 3 Distribution of Symptoms at Enrollment and Follow-Up by Use of Medications for Autoimmune Disease

	Participants at Enrollment		Participants with Follow-Up Around Day 30
	Taking Medications for Autoimmune Disease	Not Taking Medications for Autoimmune Disease	Taking Medications for Autoimmune Disease	Not Taking Medications for Autoimmune Disease
	(n=70)	(n=1,448)	(n=41)	(n=936)
Analysis endpoints	n (%)	n (%)	n (%)	n (%)
≥7 symptoms at enrollment	41 (58.6)	739 (51.0)	n/a	n/a
≥11 severity score at enrollment	40 (57.1)	708 (48.9)	n/a	n/a
≥1 symptom at follow-up around day 30	n/a	n/a	35 (85.4)	533 (56.9)
≥3 symptoms at follow-up around day 30	n/a	n/a	20 (48.8)	267 (28.5)
Shortness of Breath	30 (42.9)	443 (30.6)	10 (24.4)	106 (11.3)
Fatigue	59 (84.3)	1,092 (75.4)	25 (61.0)	290 (31.0)

Abbreviations: SD, standard deviation; IQR, interquartile range.