scholarly journals Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic

2020 ◽  
Author(s):  
Emily Peach ◽  
Megan Rutter ◽  
Peter Lanyon ◽  
Matthew J Grainge ◽  
Richard Hubbard ◽  
...  
Keyword(s):  
General Population ◽  
Healthcare Services ◽  
Mortality Rates ◽  
Published Data ◽  
List Type ◽  
Risk Of Death ◽  
Increased Risk ◽  
Working Age ◽  
Population Mortality ◽  
The Uk

AbstractObjectivesTo quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared to the general population, and compared to their pre-COVID risk.MethodsWe conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates.ResultsWe included 168,691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5-75.4) years, and 118,379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4-3838.1 per 100,000 person-years) was 1.44 (95% CI 1.42-1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared to the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared to men.ConclusionThe risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.Key messagesPeople with RAIRD had an increased risk of dying during COVID-19 from age 35 years onwards, whereas in the general population it increased from the age of 55 onwards.Women had a greater increase in their risk of death during COVID-19 compared to men.The risk of working age people with RAIRD dying during COVID-19 was similar to that of someone 20 years older in the general population.

scholarly journals Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic

Rheumatology ◽  
2020 ◽  
Author(s):  
Emily Peach ◽  
Megan Rutter ◽  
Peter Lanyon ◽  
Matthew J Grainge ◽  
Richard Hubbard ◽  
...  
Keyword(s):  
General Population ◽  
Healthcare Services ◽  
Mortality Rates ◽  
Published Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
Specific Mortality ◽  
Population Mortality ◽  
The Uk ◽  
Recorded Diagnosis

Abstract Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4–3838.1 per 100 000 person-years) was 1.44 (95% CI 1.42–1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.

scholarly journals P054 Risk of death during the 2020 UK COVID-19 epidemic among people with rare diseases compared to the general population

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Megan Rutter ◽  
Peter C Lanyon ◽  
Emily Peach ◽  
Matthew J Grainge ◽  
Richard B Hubbard ◽  
...  
Keyword(s):  
General Population ◽  
Rare Diseases ◽  
Absolute Risk ◽  
Healthcare Services ◽  
Mortality Rates ◽  
Baseline Risk ◽  
Secondary Outcome ◽  
Published Data ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background/Aims  To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 epidemic compared with baseline risk and the risk of death in the general population during COVID-19. Methods  A cohort study was performed using data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS). Coded diagnoses for RAIRD were identified from Hospital Episode Statistics from 2003 onwards. Previous coding validation work demonstrated our case ascertainment methods had a positive predictive value >85%. ONS published data were used for general population mortality rates. The main outcome measure was age-standardised mortality rates (ASMRs) for all-cause death. Secondary outcome measures were age-sex standardised mortality rates, and age-stratified mortality rates. Results  168,691 people with RAIRD were alive on 1 March 2020. Their median age was 61.7 (IQR 41.5-75.4) years, and 118,379 (70.2%) were female. 1,815 (1.1%) people with RAIRD died during March and April 2020. The ASMR among people with RAIRD was 3669.3 (95% CI 3500.4-3838.1) per 100,000 person-years, which was 1.44 (95% CI 1.42-1.45) times higher than the average ASMR during the same months of the previous 5 years. In the whole population of England, the ASMR during March and April 2020 was 1361.1 (1353.6- 1368.7) per 100,000 people, which was 1.38 times higher than the average ASMR during the same months of the previous 5 years (see related abstract about influenza seasons). Unlike in the general population, sex-specific rates in RAIRD were similar in males and females. When comparing risk of death during COVID-19 to pre-COVID-19, people with RAIRD had an increased risk of death from age 35 upwards, compared to around age 55 upwards in the general population. As the protective effect of being female was not seen in RAIRD, the group at the largest increased risk compared to their pre-COVID-19 risk were women aged 35 upwards. The absolute risk of all-cause death for someone aged 20-29 with RAIRD was similar to someone in the general population aged >20 years older, someone aged 40-49 years with RAIRD similar to someone in the general population 20 years older, and someone aged 60-69 with RAIRD similar to someone in the general population aged >10 years older. Conclusion  The excess risk of all-cause death during COVID-19 occurs at a younger age among people with RAIRD than among the general population, and particularly affects females. . We urgently need to quantify how much risk is due to COVID-19 infection and how much due to disruption to healthcare services to inform better guidance about shielding, access to healthcare and vaccine priorities for people with rare diseases. Disclosure  M. Rutter: None. P.C. Lanyon: None. E. Peach: None. M.J. Grainge: None. R.B. Hubbard: None. J. Aston: None. M. Bythell: None. S. Stevens: None. F.A. Pearce: None.

scholarly journals O24 Risk of death during the 2020 UK COVID-19 epidemic and annual influenza seasons among people with vasculitis compared to the general population: a whole-population study using data from the NDRS and the RECORDER project

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Megan Rutter ◽  
Peter C Lanyon ◽  
Matthew J Grainge ◽  
Richard B Hubbard ◽  
Emily J Peach ◽  
...  
Keyword(s):  
Mortality Rate ◽  
General Population ◽  
Mortality Rates ◽  
Published Data ◽  
Research Support ◽  
Risk Of Death ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Increased Risk ◽  
Using Data

Abstract Background/Aims  To quantify the risk of death among people with vasculitis during the UK 2020 COVID-19 epidemic compared with baseline risk, risk during annual influenza seasons and risk of death in the general population during COVID-19. Methods  We performed a cohort study using data from the National Congenital Anomaly and Rare Disease Registration Service (NCARDRS) under their legal permissions (CAG 10-02(d)/2015). Coded diagnoses for vasculitis (ANCA-associated vasculitis, Takayasu arteritis, Behçet's disease, and giant cell arteritis) were identified from Hospital Episode Statistics from 2003 onwards. Previous coding validation work demonstrated a positive predictive value >85%. The main outcome measure was age-standardised mortality rates (ASMRs) for all-cause death. ONS published data were used for general population mortality rates. Results  We identified 55,110 people with vasculitis (median age 74.9 (IQR 64.1-82.7) years, 68.0% female) alive 01 March 2020. During March-April 2020, 892 (1.6%) died of any cause. The crude mortality rate was 9773.0 (95% CI 9152.3-10,435.9) per 100,000 person-years. The ASMR was 2567.5 per 100,000 person-years, compared to 1361.1 (1353.6-1368.7) in the general population (see table). The ASMR in March-April 2020 was 1.4 times higher than the mean ASMR for March-April 2015-2019 (1965.6). The increase in deaths during March-April 2020 occurred at a younger age than in the general population. We went on to investige the effect of previous influenza seasons. The 2014/15 season saw the greatest excess all-cause mortality nationally in recent years, and there were 624 deaths in 38,888 people (6472.5 person-years) with vasculitis in our data (crude mortality rate 9640.8 (8913.3-10427.7); The ASMR was 2657.6, which was marginally higher than the ASMR among people with vasculitis recorded during March-April 2020 during the COVID-19 pandemic. Conclusion  People with vasculitis are at increased risk of death during circulating COVID-19 and influenza epidemics. The ASMR among people with vasculitis was high both during the 2014/15 influenza season and during the first wave of the COVID-19 epidemic. COVID-19 vaccination and annual influenza vaccination for people with vasculitis are both important, regardless of patient age. Disclosure  M. Rutter: None. P.C. Lanyon: Grants/research support; PCL has received funding for research from Vifor Pharma.. M.J. Grainge: None. R.B. Hubbard: None. E.J. Peach: Grants/research support; EJP has received funding for research from Vifor Pharma. M. Bythell: None. J. Aston: None. S. Stevens: None. F.A. Pearce: Grants/research support; FAP has received funding for research from Vifor Pharma..

Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?

2017 ◽  
Vol 77 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Marie Holmqvist ◽  
Lotta Ljung ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Excess Mortality ◽  
Disease Onset ◽  
Mortality Rates ◽  
Calendar Time ◽  
Risk Of Death ◽  
Quality Register ◽  
Increased Risk ◽  
New Onset

ObjectiveTo investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.MethodsUsing an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.Results17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.ConclusionsDespite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

Conditional Survival and Cause-Specific Mortality in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation (alloHCT) for Hematologic Malignancy Over Three Decades

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 606-606
Author(s):  
Saro H. Armenian ◽  
Can-Lan Sun ◽  
Tabitha Vase ◽  
George Mills ◽  
Liezl Atencio ◽  
...  
Keyword(s):  
General Population ◽  
Hematologic Malignancy ◽  
Survival Rates ◽  
Mortality Rates ◽  
Conditional Survival ◽  
Risk Of Death ◽  
Increased Risk ◽  
Risk Of Relapse ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Abstract 606 Background: alloHCT is offered with curative intent to patients with hematologic malignancies, and conventionally-computed survival estimates are offered for prognosticating outcomes. However, conventionally-computed survival estimates do not take into account elapsed time (and changing hazards with time survived); conditional survival overcomes these limitations, by calculating the probability of survival after having already survived a certain period of time – such data are unavailable for alloHCT recipients. We describe cause-specific (relapse-, GvHD-, treatment-related) conditional survival after alloHCT, providing clinically relevant information for patients who have survived 6 mos, 1, 2, and 5y after alloHCT. Methods: From 1976 to 2006, 2,427 consecutive patients received alloHCT for a hematologic malignancy at a single institution (median age: 34.7y [0.6–72.5]). Vital status and cause of death were determined using National Death Index, Social Security Death Index and medical records. Results: As of 12/31/2007, a total of 1413 deaths (58% of the cohort) were observed; 39% attributed to recurrent disease; 34% to GvHD; 12% to infection; 5% to cardiopulmonary disease; 2% to subsequent malignant neoplasm (SMNs); and 8% to other causes. Conventionally-computed probability of survival was 44.6% at 5y and 41.2% at 10y from alloHCT. On the other hand, conditional on survival for 6 mo, 1, 2, and 5y after alloHCT, 5-y survival rates were 62%, 75%, 83%, and 93%, respectively (Figure A). The cohort was at a 40-fold increased risk of any death compared with the general population (95%CI=38.2–42.4); at a 25.6-fold increased risk of death due to pulmonary complications, 3.3-fold risk due to SMNs, and 2.3-fold risk due to cardiovascular complications. Among patients followed for 15+y after HCT, the risk of all-cause mortality was 2.6-fold that of the general population (95%CI=1.8–3.7). Standardized mortality ratios (SMR) and cause-specific conditional mortality rates by primary diagnosis are summarized in the Table. Individuals who survived the first 5y had negligible (≤5%) risk of relapse- and GvHD-related mortality over the subsequent 5y. Treatment-related mortality increased over time; among those who survived 5y, treatment-related mortality rates exceeded relapse-related mortality (Figure B). After adjustment for demographics, underlying diagnosis and treatment era, individuals with chronic GVHD (cGVHD) had a significantly lower risk of relapse-related mortality (RR=0.43, 95%CI=0.4–0.5) compared to those without cGVHD. Conclusions: The projected 5-y survival rates improve conditional on time survived from alloHCT; 5-y survival exceeds 93% for those who have already survived 5y. However, alloHCT recipients who have survived 15+y continue to remain at increased risk of death compared to the general population. cGVHD is associated with decreased risk of relapse-related mortality. Both relapse-related and GvHD-related mortality rates decline with time, such that, among those who have survived 5y, treatment-related mortality exceeds relapse-related mortality. Conditional survival estimates provide clinically relevant prognostic information, helping inform preventive and interventional strategies. Disclosures: No relevant conflicts of interest to declare.

SARS-CoV-2: Possible Factors Contributing to Serious Consequences of COVID-19?

2021 ◽  
Vol 02 ◽  
Author(s):  
Ruqaiyyah Siddiqui ◽  
Mohammad Ridwane Mungroo ◽  
Mohamed Yehia Abouleish ◽  
Naveed A. Khan
Keyword(s):  
South Asian ◽  
Ethnic Diversity ◽  
Gut Microbiome ◽  
Mortality Rates ◽  
Risk Of Death ◽  
The United Kingdom ◽  
Increased Risk ◽  
The Uk ◽  
Potential Therapeutics

Background and Objectives: The recently discovered coronavirus, SARS-CoV-2 has infected over 170 million people (as of 31th May 2021) since it was elucidated in December 2019. The number of SARS-CoV-2 cases and mortality rates vary from country to country, and unfortunately, the United Kingdom ranks in the top 5 countries with the most deaths as of 31th May 2021. Methods: A literature review was conducted during May 2021 to examine if factors such as gut microbiome, ethnic diversity, high cancer rates, obesity and alcohol consumption may have contributed to the higher number of cases and mortality due to SARS-CoV-2 in the UK. Results: The western diet is associated with a less diverse gut microbiome, as well as obesity, and contributes to the severity of SARS-CoV-2 infection. Moreover, people belonging to Black and South Asian ethnic groups in the UK have an increased risk of death due to SARS-CoV-2 infection. Given the high number of cancer patients in the UK, as well as excess consumption of alcohol, higher mortality rates were observed, most likely due to people possessing a less diverse gut microbiome and/or weakened immune system. Conclusion: Targeting the gut microbiome in developing potential therapeutics against SARS-COV-2 is of value, and further studies are needed to understand the specific role of the gut microbiome.

Improving primary healthcare for the homeless

2020 ◽  
Vol 13 (6) ◽  
pp. 361-364
Author(s):  
Aarathi Krishnan ◽  
Neil H Metcalfe
Keyword(s):  
General Practice ◽  
General Population ◽  
Community Setting ◽  
Healthcare Services ◽  
Mortality Rates ◽  
Homeless Population ◽  
Community Healthcare ◽  
Healthcare Needs ◽  
The Uk ◽  
Community Healthcare Services

Homelessness is an increasing problem in the UK. One of the biggest issues faced by the homeless is their health; they have greater healthcare needs and significantly higher morbidity and mortality rates compared with the general population. However, the homeless population is far less likely to engage with community healthcare services, including general practice. Despite measures to help GPs treat the homeless population, there is still a lack of knowledge about how best to manage the health of the homeless within the community setting. This article aims to inform GPs about effective measures to improve the health of homeless patients.

scholarly journals Trends and risk factors for death and excess all-cause mortality among notified tuberculosis patients in the UK: an analysis of surveillance data

2019 ◽  
Vol 5 (4) ◽  
pp. 00125-2019
Author(s):  
Debora Pedrazzoli ◽  
Katharina Kranzer ◽  
H. Lucy Thomas ◽  
Maeve K. Lalor
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Vulnerable Groups ◽  
Mortality Data ◽  
Death Rates ◽  
Risk Of Death ◽  
Increased Risk ◽  
Depth Analysis ◽  
All Cause Mortality ◽  
The Uk

IntroductionIn the UK, several hundred patients notified with tuberculosis (TB) die every year. The aim of this article is to describe trends in deaths among notified TB patients, explore risk factors associated with death and compare all-cause mortality in TB patients with age-specific mortality rates in the general UK population.MethodsWe used 2001–2014 data from UK national TB surveillance to explore trends and risk factors for death, and population mortality data to compare age-specific death rates among notified TB patients with annual death rates in the UK general population.ResultsThe proportion of TB patients in the UK who died each year declined steadily from 7.1% in 2002 to 5.5% in 2014. One in five patients (21.3%) was diagnosed with TB post-mortem. Where information was available, almost half of the deaths occurred within 2 months of starting treatment. Risk factors for death included demographic, disease-specific and social risk factors. Age had by far the largest effect, with patients aged ≥80 years having a 70 times increased risk of death compared with those aged <15 years. In contrast, excess mortality determined by incidence ratios comparing all-cause mortality among TB patients with that of the general population was highest among children and the working-age population (15–64 years old).ConclusionsEfforts to control TB and improve diagnosis and treatment outcomes in the UK need to be sustained. Control efforts need to focus on socially deprived and vulnerable groups. There is a need for further in-depth analysis of deaths of TB patients in the UK to identify potentially preventable factors.

Mortality in ANCA-associated vasculitis: ameta-analysis of observational studies

2017 ◽  
Vol 76 (9) ◽  
pp. 1566-1574 ◽  
Author(s):  
Ju Ann Tan ◽  
Natasha Dehghan ◽  
Wenjia Chen ◽  
Hui Xie ◽  
John M Esdaile ◽  
...  
Keyword(s):  
General Population ◽  
Publication Bias ◽  
Mortality Risk ◽  
Observational Studies ◽  
Consensus Conference ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Published Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality

ObjectiveTo determine the magnitude of all-cause mortality risk in patients with antineutrophil cytoplasmic antibodies-associated vasculitis (AAV) compared with the general population through a meta-analysis of observational studies.MethodsWe searched Medline and Embase databases from their inception to April 2015. Observational studies that met the following criteria were assessed by two researchers: (1) clearly defined AAV identified by either the American College of Rheumatology 1990 classification criteria or the 2012 Chapel Hill Consensus Conference disease definitions, and (2) reported standardised mortality ratios (SMR) and 95% CI. We calculated weighted-pooled summary estimates of SMRs (meta-SMRs) for all-cause mortality using random-effects model, tested for publication bias and heterogeneity.ResultsTen studies met the inclusion criteria, comprising 3338 patients with AAV enrolled from 1966 to 2009, and a total of 1091 observed deaths. Overall, we found a 2.7-fold increased risk of death in patients with AAV when compared with the general population (meta-SMR: 2.71 (95% CI 2.26 to 3.24)). Analysis on studies that included only granulomatosis with polyangiitis cases also indicated a similar mortality risk (meta-SMR: 2.63 (95% CI 2.02 to 3.43)). There was no significant publication bias or small-study effect. Subgroup analyses showed that mortality risks were higher in older cohorts, with a trend towards improvement over time (ie, those with their midpoint of enrolment periods that were between 1980–1993 and 1994–1999, vs 2000–2005).ConclusionPublished data indicate there is a 2.7-fold increase in mortality among patients with AAV compared with the general population.

scholarly journals Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

2021 ◽  
Vol 12 ◽  
pp. 204209862098569
Author(s):  
Phyo K. Myint ◽  
Ben Carter ◽  
Fenella Barlow-Pay ◽  
Roxanna Short ◽  
Alice G. Einarsson ◽  
...  
Keyword(s):  
Medical Attention ◽  
Close Monitoring ◽  
Plain Language ◽  
Discharge Data ◽  
Specific Patient ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

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