The Interplay between Covid-19 and Spondyloarthritis or Its Treatment

Objective The Covid-19 pandemic has created multiple uncertainties regarding rheumatic diseases or their treatment and susceptibility or severity of the viral disease. Methods To address these questions as they relate to spondyloarthritis, we created a longitudinal survey from April 10, 2020 to April 26, 2021. 4723 world-wide subjects with spondyloarthritis and 450 household contacts participated. 3064 of the respondents were from the US and 70.4% of them provided longitudinal data. To control for the duration of potential risk of Covid-19, the rate of contracting Covid-19 was normalized for person months of exposure. Results In an analysis of US subjects who provided longitudinal data, the incident rate ratio for the 159 (out of 2157) subjects who tested positive for Covid-19 was 1.16 compared to the US population as adjusted for age and sex (range 0.997 to 1.361, p=0.059). A paired evaluation using patients and household members did not show a statistically significant effect to indicate a predisposition to develop Covid-19 as a result of spondyloarthritis or its treatment. Our data failed to show that any class of medication commonly used to treat spondyloarthritis significantly affected the risk to develop Covid-19 or the severity of Covid-19. Conclusion These data do not exclude a small increased risk to develop Covid-19 as a result of spondyloarthritis, but the risk, if it exists, is low and not consistently demonstrated. The data should provide reassurance to patients and to rheumatologists about the risk that Covid-19 poses to patients with spondyloarthritis.

Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013–2018

ObjectivesPeople experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics.DesignRetrospective matched cohort study.SettingHospitals in England.Participants16 161 homeless patients and 74 780 housed patients aged 16–75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis.Primary and secondary outcome measuresAnnual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015–2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients.ResultsMean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina.ConclusionsHomeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.

COVID-19 mortality risk for older men and women

Background Case-fatality from COVID-19 has been reported to be relatively high in patients age 65 years or older. We sought to determine the age-specific rates of COVID-19 mortality at the population level. Methods We obtained information regarding the total number of COVID-19 reported deaths for six consecutive weeks beginning at the 50th recorded death, among 16 countries that reported a relatively high number of COVID-19 cases as of April 12, 2020. We performed an ecological study to model COVID-19 mortality rates per week by age group (54 years or younger, 55–64 years, and 65 years or older) and sex using a Poisson mixed effects regression model. Results Over the six-week period of data, there were 178,568 COVID-19 deaths from a total population of approximately 2.4 billion people. Age and sex were associated with COVID-19 mortality. Compared with individuals ages 54 years or younger, the incident rate ratio (IRR) was 8.1, indicating that the mortality rate of COVID-19 was 8.1 times higher (95%CI = 7.7, 8.5) among those 55 to 64 years, and more than 62 times higher (IRR = 62.1; 95%CI = 59.7, 64.7) among those ages 65 or older. Mortality rates from COVID-19 were 77% higher in men than in women (IRR = 1.77, 95%CI = 1.74, 1.79). Conclusions In the 16 countries examined, persons age 65 years or older had strikingly higher COVID-19 mortality rates compared to younger individuals, and men had a higher risk of COVID-19 death than women.

Behavioural and Physiological Response to Frustration in Autistic Youth: Associations with Irritability

Background: Irritability is a common and impairing occurrence in autistic youth, yet the underlying mechanisms are not well known. In typically developing populations, differences in frustration response have been suggested as important driver of the behavioural symptoms of irritability. Research exploring the role of frustration response as a risk factor for irritability in autistic populations is limited and often uses on parent report or observer ratings; objective measures of frustration response appropriate for use in autistic populations are required to advance the field. Methods: In the current study, fifty-two autistic adolescents aged 13-17 years from a population-based longitudinal study completed an experimental task designed to induce frustration through exposure to periods of unexpected delay. Behavioural (number of button presses) and physiological (heart rate; HR) metrics were collected during delay periods. Irritability was measured using the parent-rated Affective Reactivity Index (ARI). Analyses used mixed-level models to test whether irritability was associated with different slopes of behavioural and physiological response in response to experimentally induced frustration. Age and baseline HR (for the physiological data only) were included as covariates. Results: Analyses showed a marginal association between irritability and the slope of behavioural response (incident rate ratio=.98, p=.06), and a significant association with the slope of physiological response (b=-.10, p=.04); higher levels of irritability were associated with a dampened behavioural and physiological response, as indicated by flatter slopes of change over the course of the task. This pattern of results remained when adjusting for IQ, autism symptom severity and medication use (association between irritability and slope of behavioural response: incident rate ratio=.98, p=.02; slope of HR response; b=-.10, p=.04). Conclusions: Results suggest that the current experimental task may be a useful objective measure of frustration response for use with autistic populations, and that a non-adaptive response to frustration may be one biological mechanism underpinning irritability in autistic youth. This may represent an important target for future intervention studies.

1381. Rotavirus Gastroenteritis among older adults: discussion based on a systematic literature review

Background While the burden of Rotavirus Gastroenteritis (RGE) is well recognized in young children, it is less so in older adults. However, older adults are also at high-risk of Acute Gastroenteritis (AGE) severe outcomes. In this review, we thus aimed to comprehensively assess RGE burden and vaccination impact in older individuals. Methods We performed a systematic literature review with PubMed and Scopus, from 2000 to 2019, using MESH and free-range terms. We included only studies that reported the incidence, and/or RV vaccination impact, in adults aged 60 and above and using regional specific data-sources. Results We analyzed 11 manuscripts for individuals aged 60 and above (Figure 1). Studies spanned Australia, Sweden, Netherlands, Canada (2), Germany (2), UK (2), and the US (2). Yearly inpatient RV incidence varied between 1.6 per 100,000 in Australia for those 65+ (retrospective database analyses, pre-vaccine); and 26 per 100,000 for those 85+ in Canada (modeling estimates for 2006-10, pre-vaccine). The incidence rate ratio for inpatient RGE between the post and pre-vaccine periods for those 65+ was 0.57 [95% CI: 0.10 – 3.15] in Canada, but 2.24 [95%CI: 1.78-2.83] in Australia, which may be due to increased testing for RV in the elderly post-vaccine. Reductions in the post-vaccination burden of RV and AGE among 60+ were reported in the UK (2 studies), and the US (2 studies) via retrospective database analyses In the UK, post-vaccine reductions in AGE health care-utilization were reported in the Emergency Department (21%), and outpatient centers (walk-in centers: 47%; general practice consultations: 36%). Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period. Retrospective database analyses documenting the incident rate ratio (IRR) of Rotavirus Gastroenteritis (RGE) and Acute Gastroenteritis (AGE) in older adults between the pre and post-vaccine period. Conclusion While the burden of RGE mainly falls on young children, it also affects older adults. Retrospective database analyses reveal that, likely due to indirect vaccination benefits, increases in RV vaccination coverage have had an impact on lowering RGE, and AGE cases and healthcare utilization in older adults, a group at high-risk of severe outcomes for AGE. Disclosures Cristina Carias, PhD, Merck (Employee, Shareholder) Susanne Hartwig, n/a, MSD Vaccins (Employee) M.Nabi Kanibir, MD, Merck/MSD (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder)

106 Neighbourhood socioeconomic deprivation and assault injuries in urban youth

Introduction/Background Youth violence is a major global public health concern. Assault injuries are a major cause of trauma among youth, yet the causes for and medical consequences of assault victimization in this group remain uncertain. Objectives Using data from the third-largest urban area in Canada, we sought to describe the demographic, temporal and geographic influences on the incidence of youth assault injuries. Design/Methods We performed a population-based cross sectional study of Canadian youth aged 10 to 24 years seeking emergency medical care between April 2012 and March 2018 at any of the 16 hospitals in a major Canadian metropolitan area. Injury characteristics were described using graphical and statistical techniques. Neighbourhood material and social deprivation indices were examined as independent predictors of the population incidence of youth assault injury using negative binomial regression and geospatial methods. Results A total of 2,784 assaulted youth sought emergency medical care during the 6-year study interval, corresponding to an incidence rate of 101 youth assault injuries per 100,000 person-years. Assaulted youth were most commonly males between 20 and 24 years of age. Prior diagnoses of substance use and mental health disorders were common. Examination of temporal variation in the incidence of assault injury revealed a 103-fold difference between the riskiest and safest hours of the week (incident rate ratio, 103). The risk of youth assault injury in the most materially deprived quintile of neighbourhoods was more than four-fold greater than that in the wealthiest quintile (incident rate ratio per quintile increase, 1.42; 95%CI [1.27, 1.59]; p <0.001), and the risk of youth assault injury in the most socially deprived quintile of neighbourhoods was more than twelve-fold greater than that in the least deprived quintile (incident rate ratio per quintile increase, 1.88; 95%CI [1.69, 2.11]; p <0.001). Conclusion Assault injuries among youth vary substantially across time and space. Targeted violence prevention interventions might focus on weekend evenings and on socioeconomically deprived neighbourhoods.

Hospitalization Rates in Older Adults With Albuminuria: The Cardiovascular Health Study

Background Albuminuria is highly prevalent among older adults, especially those with diabetes. It is associated with several chronic diseases, but its overall impact on the health of older adults, as measured by hospitalization, has not been quantified. Method We followed up 3,110 adults, mean age 78 years, for a median 9.75 years, of whom 654 (21%) had albuminuria (≥30 mg albumin/gram creatinine) at baseline. Poisson regression models, adjusted for cardiovascular, renal, and demographic factors, were used to evaluate the association of albuminuria with all-cause and cause-specific hospitalizations, as defined by ICD, version 9, categories. Results The rates of hospitalization per 100 patient-years were 65.85 for participants with albuminuria and 37.55 for participants without albuminuria. After adjustment for covariates, participants with albuminuria were more likely to be hospitalized for any cause than participants without albuminuria (incident rate ratio, 1.39 [95% confidence intervals, 1.27. 1.53]) and to experience more days in hospital (incident rate ratio 1.56 [1.37, 1.76]). The association of albuminuria with hospitalization was similar among participants with and without diabetes (adjusted incident rate ratio for albuminuria versus no albuminuria: diabetes 1.37 [1.11, 1.70], no diabetes 1.40 [1.26, 1.55]; p interaction nonsignificant). Albuminuria was significantly associated with hospitalization for circulatory, endocrine, genitourinary, respiratory, and injury categories. Conclusions Albuminuria in older adults is associated with an increased risk of hospitalization for a broad range of illnesses. Albuminuria in the presence or absence of diabetes appears to mark a generalized vulnerability to diseases of aging among older adults.

Changing epidemiology of nontuberculous mycobacterial lung disease over the last two decades in a region of the Basque country

Recent studies suggest an increasing prevalence of nontuberculous mycobacteria (NTM) lung disease. The aim of the present study was to describe incidence rates of NTM lung disease and trends therein in our area over a 20-year period.This was a retrospective study of all cases of NTM lung disease between 1997 and 2016 that met the 2007 American Thoracic Society criteria. We analysed the annual incidence rates, species of mycobacteria isolated, trends over time and annual mortality in 327 patients.Mycobacterium kansasii was the most common mycobacterium isolated (84%), followed by Mycobacterium avium complex (MAC) (13%). We compared two periods: 1997–2006 (257 cases, 79%) and 2007–2016 (70 cases, 21%). The incidence rates tended to decrease across these years, with a peak of incidence in 2000 with 10.6 cases per 100 000. There was a clearly decreasing trend in M. kansasii infection, not only in the first period (incident rate ratio (IRR) 0.915, 95% CI 0.88–0.90; p<0.0001) but also in the second (IRR 0.869, 95% CI 0.780–1.014; p=0.080), reaching 1.8 per 100 000 in 2016. In contrast, MAC infection tended to increase across the two periods (IRR 1.251, 95% CI 1.081–1.447; p=0.003).In our region, the incidence of NTM lung disease has notably decreased in recent years. M. kansasii had high incidence rates in the first decade but clearly decreased in the second decade.

Bikeability: Assessing the Objectively Measured Environment in Relation to Recreation and Transportation Bicycling

The objectives of this study were to examine the association between objectively measured environmental variables and transportation and recreation bicycling frequency, and to develop transportation and recreation bikeability indices. Exploratory factor analysis was used to identify the underlying essential structure of the environmental variables under consideration. Many environmental variables were found to be correlated with transportation bicycling frequency, but not recreation bicycling frequency. The final transportation bikeability index included the combined effect of bicycle lanes, residential density, population density, ozone level, distance to transit, parks, and tree canopy coverage, and was found to have a significant direct association with any past-year transportation bicycling (odds ratio [OR] = 1.42, 95% confidence interval [CI] = [1.35, 1.52]) and transportation bicycling frequency (incident rate ratio [IRR] = 1.14, 95% CI = [1.09, 1.19]). This work will help advance research on bicycling and public health by providing a tool that can be utilized to examine transportation bicycling and the objective environment in the context of the United States.