Comparative Burden of COVID-19 in Adults with Rheumatic Diseases and Immunocompetent Individuals: A Population-Based Cohort Study in Quebec, Canada, 2020-2023
- 1Institut national de santé publique du Québec
Abstract
IntroductionAcross major phases of the COVID-19 pandemic (March 2020-April 2023), we compared the burden of severe COVID-19 among individuals with systemic autoimmune rheumatic diseases (SARDs) versus immunocompetent individuals with and without comorbidities.
MethodsThis population-based cohort study used administrative datasets to estimate crude and age-and sex-standardized SARS-CoV-2 and severe COVID-19 incidences among adults >18 years with SARDs, chronic comorbidities, or no comorbidities. Relative to the latter, we used Cox models to derive adjusted hazard ratios (aHRs) for infection, hospitalization, and intensive care unit admission or death (ICU/death) during the pre-vaccination (March-December 2020), vaccination pre-Omicron (December 2020- December 2021), and Omicron (December 2021-April 2023) periods.
ResultsWe included 81,434 adults with SARDs, and 2,020,356 with comorbidities versus 3,144,700 without comorbidities. Despite similar adjusted infection rates, the SARDS cohort had higher risks of hospitalization and ICU/death during the pre-vaccination period (aHRs: 3.4, 95%CI:2.8-4.1; and 4.0, 95%CI:2.8-5.7, respectively), persisting through the Omicron period (aHRs: 4.5, 95%CI:4.0-4.9; and 4.4, 95%CI:3.6-5.4, respectively). Among SARDS, rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus contributed highest burden, with comparable hospitalization and mortality rates among younger rheumatoid arthritis versus healthy older adults. Highly immunosuppressive rituximab-or mycophenolate-treated patients had highest hospitalization and ICU/death risks, particularly during the Omicron period (aHRs: 11.9, 95%CI:9.9-14.3; and 17.6, 95%CI:13.0- 23.9, respectively).
ConclusionIndividuals with SARDs, especially receiving highly immunosuppressive therapies, experienced elevated COVID-19 burden and severe outcome risks throughout the pandemic, warranting their prioritized consideration during future public health emergencies.
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BibTeX
@misc{carazo2026comparative,
title = {{Comparative Burden of COVID-19 in Adults with Rheumatic Diseases and Immunocompetent Individuals: A Population-Based Cohort Study in Quebec, Canada, 2020-2023}},
author = {S. Carazo and I. Colmegna and S. Bernatsky and P. R. Fortin and S. Jean and D. Talbot and L. Rochette and C.-A. Guay and M. Libman and M. Desjardins and C. Quach and D. M. Skowronski and G. De Serres and Canadian Immunization Research Network},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.21.26363556},
url = {https://www.medrxiv.org/content/10.64898/2026.09.21.26363556v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Comparative Burden of COVID-19 in Adults with Rheumatic Diseases and Immunocompetent Individuals: A Population-Based Cohort Study in Quebec, Canada, 2020-2023
AU - S. Carazo
AU - I. Colmegna
AU - S. Bernatsky
AU - P. R. Fortin
AU - S. Jean
AU - D. Talbot
AU - L. Rochette
AU - C.-A. Guay
AU - M. Libman
AU - M. Desjardins
AU - C. Quach
AU - D. M. Skowronski
AU - G. De Serres
AU - Canadian Immunization Research Network
PY - 2026
DA - 2026/09/21
PB - medRxiv
DO - 10.64898/2026.09.21.26363556
UR - https://www.medrxiv.org/content/10.64898/2026.09.21.26363556v1
AB - IntroductionAcross major phases of the COVID-19 pandemic (March 2020-April 2023), we compared the burden of severe COVID-19 among individuals with systemic autoimmune rheumatic diseases (SARDs) versus immunocompetent individuals with and without comorbidities. MethodsThis population-based cohort study used administrative datasets to estimate crude and age-and sex-standardized SARS-CoV-2 and severe COVID-19 incidences among adults >18 years with SARDs, chronic comorbidities, or no comorbidities. Relative to the latter, we used Cox models to derive adjusted hazard ratios (aHRs) for infection, hospitalization, and intensive care unit admission or death (ICU/death) during the pre-vaccination (March-December 2020), vaccination pre-Omicron (December 2020- December 2021), and Omicron (December 2021-April 2023) periods. ResultsWe included 81,434 adults with SARDs, and 2,020,356 with comorbidities versus 3,144,700 without comorbidities. Despite similar adjusted infection rates, the SARDS cohort had higher risks of hospitalization and ICU/death during the pre-vaccination period (aHRs: 3.4, 95%CI:2.8-4.1; and 4.0, 95%CI:2.8-5.7, respectively), persisting through the Omicron period (aHRs: 4.5, 95%CI:4.0-4.9; and 4.4, 95%CI:3.6-5.4, respectively). Among SARDS, rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus contributed highest burden, with comparable hospitalization and mortality rates among younger rheumatoid arthritis versus healthy older adults. Highly immunosuppressive rituximab-or mycophenolate-treated patients had highest hospitalization and ICU/death risks, particularly during the Omicron period (aHRs: 11.9, 95%CI:9.9-14.3; and 17.6, 95%CI:13.0- 23.9, respectively). ConclusionIndividuals with SARDs, especially receiving highly immunosuppressive therapies, experienced elevated COVID-19 burden and severe outcome risks throughout the pandemic, warranting their prioritized consideration during future public health emergencies.
ER -