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Incident autoimmune diseases in association with SARS-CoV-2 infection: a matched cohort study

Falko TeschCenter for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany. [email protected]Franz EhmCenter for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, GermanyAnnika ViviritoInGef - Institute for Applied Health Research Berlin GmbH, Berlin, GermanyDanny WendeManuel BatramFriedrich LoserTechniker Krankenkasse, Hamburg, GermanySimone MenzerIKK classic, Dresden, GermanyJosephine JacobInGef - Institute for Applied Health Research Berlin GmbH, Berlin, GermanyMartin RoesslerMartin SeifertCenter for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, GermanyBarbara KindCenter for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, GermanyChristina KönigTechniker Krankenkasse, Hamburg, GermanyClaudia SchulteTilo BuschmannDagmar HertlePedro BallesterosStefan BaßlerBarbara BerteleTechniker Krankenkasse, Hamburg, GermanyThomas BittererIKK classic, Dresden, GermanyCordula RiedererDAK-Gesundheit, Hamburg, GermanyFranziska SobikDAK-Gesundheit, Hamburg, GermanyLukas ReitzleRobert Koch Institute, Berlin, GermanyChrista Scheidt‐NaveRobert Koch Institute, Berlin, GermanyJochen SchmittCenter for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany

2023en

ABI

Annotatsiya

OBJECTIVES: To investigate whether the risk of developing an incident autoimmune disease is increased in patients with prior COVID-19 disease compared to those without COVID-19, a large cohort study was conducted. METHOD: A cohort was selected from German routine health care data. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through December 31, 2020. Patients were matched 1:3 to control patients without COVID-19. Both groups were followed up until June 30, 2021. We used the four quarters preceding the index date until the end of follow-up to analyze the onset of autoimmune diseases during the post-acute period. Incidence rates (IR) per 1000 person-years were calculated for each outcome and patient group. Poisson models were deployed to estimate the incidence rate ratios (IRRs) of developing an autoimmune disease conditional on a preceding diagnosis of COVID-19. RESULTS: In total, 641,704 patients with COVID-19 were included. Comparing the incidence rates in the COVID-19 (IR=15.05, 95% CI: 14.69-15.42) and matched control groups (IR=10.55, 95% CI: 10.25-10.86), we found a 42.63% higher likelihood of acquiring autoimmunity for patients who had suffered from COVID-19. This estimate was similar for common autoimmune diseases, such as Hashimoto thyroiditis, rheumatoid arthritis, or Sjögren syndrome. The highest IRR was observed for autoimmune diseases of the vasculitis group. Patients with a more severe course of COVID-19 were at a greater risk for incident autoimmune disease. CONCLUSIONS: SARS-CoV-2 infection is associated with an increased risk of developing new-onset autoimmune diseases after the acute phase of infection. Key Points • In the 3 to 15 months after acute infection, patients who had suffered from COVID-19 had a 43% (95% CI: 37-48%) higher likelihood of developing a first-onset autoimmune disease, meaning an absolute increase in incidence of 4.50 per 1000 person-years over the control group. • COVID-19 showed the strongest association with vascular autoimmune diseases.

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DOI: 10.1007/s10067-023-06670-0

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