{"doi":"10.1093/cid/ciab407","title":"Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases","abstract":"BACKGROUND: People with autoimmune or inflammatory conditions taking immunomodulatory/suppressive medications may have higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences. METHODS: We included participants with autoimmune or inflammatory conditions followed by specialists at Johns Hopkins. Participants completed periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. We assessed whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterized pandemic-associated changes to care and mental health. RESULTS: In total, 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medications) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in models incorporating behavior and other potential confounders (odds ratio [OR]: 1.43; 95% confidence interval [CI]: 1.08, 1.89). Other medication classes were not associated with COVID-19 risk. Diabetes (OR: 1.72; 95% CI: 1.08, 2.73), cardiovascular disease (OR: 1.68; 95% CI: 1.24, 2.28), and kidney disease (OR: 1.76; 95% CI: 1.04, 2.97) were associated with higher odds of COVID-19. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions therein, which disproportionately affected individuals experiencing changes to employment or income. CONCLUSIONS: Glucocorticoid exposure may increase risk of COVID-19 in people with autoimmune or inflammatory conditions. Disruption to healthcare and related services was common. Those with pandemic-related reduced income may be most vulnerable to care disruptions.","journal":"Clinical Infectious Diseases","year":2021,"id":186484,"datarank":0.4636563680037475,"base_score":3.091042453358316,"endowment":3.091042453358316,"self_citation_contribution":0.4636563680037475,"citation_network_contribution":0.0,"self_endowment_contribution":0.4636563680037475,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":21,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.949,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":369540,"name":"Christopher A. Mecoli","orcid":"0000-0002-1429-8392","position":1,"is_corresponding":false},{"id":302257,"name":"Morgan Douglas","orcid":"0000-0003-0749-7606","position":2,"is_corresponding":false},{"id":634116,"name":"Samantha Harris","orcid":"0000-0003-4274-0587","position":3,"is_corresponding":false},{"id":303457,"name":"Berna Aravidis","orcid":null,"position":4,"is_corresponding":false},{"id":257453,"name":"Jemima Albayda","orcid":"0000-0002-8030-9504","position":5,"is_corresponding":false},{"id":241641,"name":"Elias S. Sotirchos","orcid":"0000-0002-8812-1637","position":6,"is_corresponding":false},{"id":227211,"name":"Ahmet Höke","orcid":"0000-0003-1215-3373","position":7,"is_corresponding":false},{"id":376863,"name":"Ana‐Maria Orbai","orcid":"0000-0001-8644-8567","position":8,"is_corresponding":false},{"id":278767,"name":"Michelle Petri","orcid":"0000-0003-1441-5373","position":9,"is_corresponding":false},{"id":257459,"name":"Lisa Christopher‐Stine","orcid":"0000-0002-7150-7306","position":10,"is_corresponding":false},{"id":399734,"name":"Alan N. Baer","orcid":"0000-0001-8344-013X","position":11,"is_corresponding":false},{"id":257450,"name":"Julie J. Paik","orcid":"0000-0001-8436-1601","position":12,"is_corresponding":false},{"id":687565,"name":"Brittany L. Adler","orcid":"0000-0001-9912-2435","position":13,"is_corresponding":false},{"id":257454,"name":"Eleni Tiniakou","orcid":"0000-0003-4749-870X","position":14,"is_corresponding":false},{"id":744610,"name":"Homa Timlin","orcid":"0000-0002-4320-8106","position":15,"is_corresponding":false},{"id":241629,"name":"Pavan Bhargava","orcid":"0000-0002-7947-9418","position":16,"is_corresponding":false},{"id":615362,"name":"Scott D. Newsome","orcid":"0000-0002-5284-4681","position":17,"is_corresponding":false},{"id":328902,"name":"Arun Venkatesan","orcid":"0000-0002-9335-7361","position":18,"is_corresponding":false},{"id":262668,"name":"Vinay Chaudhry","orcid":"0000-0001-5625-7989","position":19,"is_corresponding":false},{"id":257667,"name":"Thomas E. Lloyd","orcid":"0000-0003-4756-3700","position":20,"is_corresponding":false},{"id":250734,"name":"Carlos A. Pardo","orcid":"0000-0002-4128-5335","position":21,"is_corresponding":false},{"id":590628,"name":"Barney J. Stern","orcid":"0000-0001-8745-538X","position":22,"is_corresponding":false},{"id":668152,"name":"Mark Lazarev","orcid":"0000-0002-5517-3588","position":23,"is_corresponding":false},{"id":744611,"name":"Brindusa Truta","orcid":"0000-0003-4319-9278","position":24,"is_corresponding":false},{"id":280480,"name":"Shiv Saidha","orcid":"0000-0001-6387-0714","position":25,"is_corresponding":false},{"id":379365,"name":"Edward S. Chen","orcid":"0000-0003-0723-8209","position":26,"is_corresponding":false},{"id":468965,"name":"Michelle Sharp","orcid":"0000-0002-1552-2579","position":27,"is_corresponding":false},{"id":497798,"name":"Nisha A. Gilotra","orcid":"0000-0002-4511-8008","position":28,"is_corresponding":false},{"id":97063,"name":"Edward K. Kasper","orcid":"0000-0002-5730-5433","position":29,"is_corresponding":false},{"id":744612,"name":"Allan C. Gelber","orcid":"0000-0001-8463-311X","position":30,"is_corresponding":false},{"id":55628,"name":"Clifton O. Bingham","orcid":"0000-0002-4752-5029","position":31,"is_corresponding":false},{"id":313830,"name":"Ami A. Shah","orcid":"0000-0002-1139-2009","position":32,"is_corresponding":false},{"id":745351,"name":"Ellen M Mowry","orcid":null,"position":33,"is_corresponding":false},{"id":241632,"name":"Kathryn C. Fitzgerald","orcid":"0000-0003-3137-0322","position":0,"is_corresponding":true}],"reference_count":29,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:48:46.850806Z","pmid":"33956972","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}