COVID-19 associated with increased risk for autoimmune inflammatory rheumatic diseases up to a year after infection

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. COVID-19 associated with increased risk for autoimmune inflammatory rheumatic diseases up to a year after infection

Vaccination showed some protection against AIRDs, depending on severity of infection

Abstract:https://www.acpjournals.org/doi/10.7326/M23-1831  

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A large, binational study found that SARS-CoV-2 infection was associated with an increased risk for autoimmune inflammatory rheumatic diseases (AIRDs) that extends up to 12 months after infection. The risk was found to be higher with greater severity of acute COVID-19, even among those who were vaccinated. These findings suggest that care strategies for patients who survive COVID-19 should pay close attention to manifestations of AIRD, particularly after severe illness. The study is published in Annals of Internal Medicine.

Emerging data suggest a higher risk for AIRDs among persons with a history of COVID-19. However, these findings are based entirely on comparisons between groups infected with SARS-CoV-2 and those that are not, which might be biased by differences in health-seeking behavior and inherent risk factors within the groups. In addition, studies have not explored the effect of vaccination and other modifiable factors on prevention of long term COVID-19 complications.

Researchers from Kyung Hee University, Seoul, South Korea used data from two national, large-scale, general population-based cohort studies in Korea and Japan to investigate the effect of COVID-19 on long-term risk for incident AIRD over various follow-up periods. The data comprised of more than 10 million Korean and 12 million Japanese adults, including those with COVID-19 between January 2020 and December 2021, matched to patients with influenza infection and to uninfected control patients. The researchers assessed the data for onset of AIRD at 1, 6, and 12 months after COVID-19 or influenza infection, or the respective matched index date of uninfected control patients. They found increased risk for incident AIRD up to 12 months after COVID-19 diagnosis compared with the other two groups. Greater severity of acute COVID-19 was associated with higher risk for incident AIRD. The authors noted that COVID-19 vaccination was associated with reduced risk for incident AIRD after SARS-CoV-2 infection, except for among those who had severe COVID-19 despite vaccination.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding authors Dong Keon Yon, MD, PhD, and Hayeon Lee, PhD, please contact yonkkang@gmail.com or wwhy28@khu.ac.kr.

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2. ACP reviews performance measures for major depressive disorder

Technology improvements would help accurately measure appropriate management

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3077  

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A review by the American College of Physicians (ACP) of performance measures designed to evaluate quality of care for those suffering from major depressive disorder (MDD) found only one of eight measures relevant to internal medicine physicians to be valid. The paper is published in Annals of Internal Medicine.

MDD is a severe mood disorder that affects at least 8.4% of the adult population in the U.S. Some characteristics of MDD include persistent sadness, diminished interest in daily activities, and a state of hopelessness. MDD may progress quickly and have devastating consequences if left untreated.  

Eight performance measures are available to evaluate screening, diagnosis, and successful management of MDD. However, many performance measures do not meet the validity, reliability, evidence, and meaningfulness criteria. Out of eight performance measures, ACP’s Performance Measurement Committee found only one measure, Suicide Risk Assessment, valid at all levels of attribution. This performance measure evaluates the frequency of suicide risk assessment for patients with a new diagnosis of MDD. The performance measure is clinically sound, evidence-based, and tested appropriately with valid and reliable results.

A January 2023 ACP clinical guideline recommends monotherapy with cognitive behavioral therapy (CBT) or with a second-generation antidepressant as an initial treatment in patients in the acute phase of moderate to severe MDD. Despite strong evidence around appropriate treatment for MDD after an initial diagnosis, there are currently no performance measures to fill this gap. However, there are feasibility challenges with the data needed for such a performance measure, including but not limited to ICD-10 coding and capturing CBT recommendations.

There is a need for systemwide technological improvements to extract the necessary data and support proper coding for MDD management. The paper suggests that data interoperability is needed to improve reporting for performance measures that can move the quality needle and reduce the burden of performance measurement on physicians, group practices and health systems.    

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andrew Hachadorian at AHachadorian@acponline.org.

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3. Patterns of all-cause mortality among Hispanic/Latino adults from diverse background groups were altered during the COVID-19 pandemic

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1990   

Editorial: https://www.acpjournals.org/doi/10.7326/M24-0249   

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A study of more than 15,000 Hispanic/Latino adults of Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds found that the patterns of all-cause mortality among these groups were altered during the COVID-19 pandemic, persons of Central American and Mexican backgrounds may have been particularly affected. The study is published in Annals of Internal Medicine. 

Hispanic/Latino persons in the United States represent diverse backgrounds and have differing health-related exposures. Previous research showed that mortality varies by Hispanic/Latino background and by proxy measures of acculturation, such as place of birth and age at immigration to the United States, with lower mortality among immigrants than U.S.-born persons and among those who immigrated at older than at younger ages. However, comprehensive data on morbidity and mortality in Hispanic/Latino background groups is still lacking. 

Researchers analyzed data on 15,568 adults aged 18 to 74 years at baseline (2008-2011) who participated in the HCHS/SOL (Hispanic Community Health Study/Study of Latinos). Participants were of Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and other backgrounds and were recruited from the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California. The study described cumulative all-cause mortality risk through 2021 by Hispanic/Latino background (and factors underlying any differences), before and during the COVID-19 pandemic. The authors found that prior to the COVID-19 pandemic, 11-year cumulative mortality risks were higher in the Puerto Rican and Cuban background groups and lowest in the South American background group. These differences were explained by lifestyle and clinical factors. However, the mortality risk pattern changed during the COVID-19 pandemic: 2-year cumulative mortality risks ranged from 1%-2% and within that narrow range were highest in persons of Central American and Mexican backgrounds and lowest among those of Puerto Rican and Cuban backgrounds in the fully adjusted analysis. Lifestyle and clinical factors appeared to play a role in this alteration in mortality pattern. 

An accompanying editorial by authors from Columbia University argues that these findings underscore the need to address the major gap in health research on the effects of structural factors, health behaviors, and social factors, such as discrimination and access to health resources, across Hispanic/Latino background groups. The authors also note that HCHS/SOL can help to advance knowledge of the structural and social drivers of health among the various communities on which the study is focused and promote better understanding of the acculturation and lifestyle factors that contribute to different patterns of mortality among Hispanic/Latino background groups. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Jianwen Cai, PhD, please contact Meg Palmer at sphcomm@unc.edu.