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Article: Risk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study

TitleRisk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study
Authors
KeywordsAutoimmune disorders
COVID-19 vaccine
SARS-CoV-2
Issue Date16-Aug-2023
PublisherElsevier
Citation
EClinicalMedicine, 2023, v. 63 How to Cite?
Abstract

Background

Case reports suggest that SARS-CoV-2 infection could lead to immune dysregulation and trigger autoimmunity while COVID-19 vaccination is effective against severe COVID-19 outcomes. We aim to examine the association between COVID-19 and development of autoimmune diseases (ADs), and the potential protective effect of COVID-19 vaccination on such an association.

Methods

A retrospective cohort study was conducted in Hong Kong between 1 April 2020 and 15 November 2022. COVID-19 was confirmed by positive polymerase chain reaction or rapid antigen test. Cox proportional hazard regression with inverse probability of treatment weighting was applied to estimate the risk of incident ADs following COVID-19. COVID-19 vaccinated population was compared against COVID-19 unvaccinated population to examine the protective effect of COVID-19 vaccination on new ADs.

Findings

The study included 1,028,721 COVID-19 and 3,168,467 non-COVID individuals. Compared with non-COVID controls, patients with COVID-19 presented an increased risk of developing pernicious anaemia [adjusted Hazard Ratio (aHR): 1.72; 95% Confidence Interval (CI): 1.12–2.64]; spondyloarthritis [aHR: 1.32 (95% CI: 1.03–1.69)]; rheumatoid arthritis [aHR: 1.29 (95% CI: 1.09–1.54)]; other autoimmune arthritis [aHR: 1.43 (95% CI: 1.33–1.54)]; psoriasis [aHR: 1.42 (95% CI: 1.13–1.78)]; pemphigoid [aHR: 2.39 (95% CI: 1.83–3.11)]; Graves' disease [aHR: 1.30 (95% CI: 1.10–1.54)]; anti-phospholipid antibody syndrome [aHR: 2.12 (95% CI: 1.47–3.05)]; immune mediated thrombocytopenia [aHR: 2.1 (95% CI: 1.82–2.43)]; multiple sclerosis [aHR: 2.66 (95% CI: 1.17–6.05)]; vasculitis [aHR: 1.46 (95% CI: 1.04–2.04)]. Among COVID-19 patients, completion of two doses of COVID-19 vaccine shows a decreased risk of pemphigoid, Graves' disease, anti-phospholipid antibody syndrome, immune-mediated thrombocytopenia, systemic lupus erythematosus and other autoimmune arthritis.

Interpretation

Our findings suggested that COVID-19 is associated with an increased risk of developing various ADs and the risk could be attenuated by COVID-19 vaccination. Future studies investigating pathology and mechanisms would be valuable to interpreting our findings.

Funding

Supported by RGC Collaborative Research Fund (C7154-20GF).


Persistent Identifierhttp://hdl.handle.net/10722/332021
ISSN
2023 Impact Factor: 9.6
2023 SCImago Journal Rankings: 3.522
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorPeng, Kuan-
dc.contributor.authorLi, Xue-
dc.contributor.authorYang, Deliang-
dc.contributor.authorChan, Shirley CW-
dc.contributor.authorZhou, Jiayi-
dc.contributor.authorWan, Eric YF-
dc.contributor.authorChui, Celine SL-
dc.contributor.authorLai, Francisco TT-
dc.contributor.authorWong, Carlos KH-
dc.contributor.authorChan, Esther WY-
dc.contributor.authorLeung, Wai Keung-
dc.contributor.authorLau, Chak-Sing-
dc.contributor.authorWong, Ian CK-
dc.date.accessioned2023-09-28T05:00:19Z-
dc.date.available2023-09-28T05:00:19Z-
dc.date.issued2023-08-16-
dc.identifier.citationEClinicalMedicine, 2023, v. 63-
dc.identifier.issn2589-5370-
dc.identifier.urihttp://hdl.handle.net/10722/332021-
dc.description.abstract<h3>Background</h3><p>Case reports suggest that SARS-CoV-2 infection could lead to immune dysregulation and trigger autoimmunity while COVID-19 vaccination is effective against severe COVID-19 outcomes. We aim to examine the association between COVID-19 and development of autoimmune diseases (ADs), and the potential protective effect of COVID-19 vaccination on such an association.</p><h3>Methods</h3><p>A retrospective cohort study was conducted in Hong Kong between 1 April 2020 and 15 November 2022. COVID-19 was confirmed by positive polymerase chain reaction or rapid antigen test. Cox proportional hazard regression with inverse probability of treatment weighting was applied to estimate the risk of incident ADs following COVID-19. COVID-19 vaccinated population was compared against COVID-19 unvaccinated population to examine the protective effect of COVID-19 vaccination on new ADs.</p><h3>Findings</h3><p>The study included 1,028,721 COVID-19 and 3,168,467 non-COVID individuals. Compared with non-COVID controls, patients with COVID-19 presented an increased risk of developing pernicious anaemia [adjusted Hazard Ratio (aHR): 1.72; 95% Confidence Interval (CI): 1.12–2.64]; spondyloarthritis [aHR: 1.32 (95% CI: 1.03–1.69)]; rheumatoid arthritis [aHR: 1.29 (95% CI: 1.09–1.54)]; other autoimmune arthritis [aHR: 1.43 (95% CI: 1.33–1.54)]; psoriasis [aHR: 1.42 (95% CI: 1.13–1.78)]; pemphigoid [aHR: 2.39 (95% CI: 1.83–3.11)]; Graves' disease [aHR: 1.30 (95% CI: 1.10–1.54)]; anti-phospholipid antibody syndrome [aHR: 2.12 (95% CI: 1.47–3.05)]; immune mediated thrombocytopenia [aHR: 2.1 (95% CI: 1.82–2.43)]; multiple sclerosis [aHR: 2.66 (95% CI: 1.17–6.05)]; vasculitis [aHR: 1.46 (95% CI: 1.04–2.04)]. Among COVID-19 patients, completion of two doses of COVID-19 vaccine shows a decreased risk of pemphigoid, Graves' disease, anti-phospholipid antibody syndrome, immune-mediated thrombocytopenia, systemic lupus erythematosus and other autoimmune arthritis.</p><h3>Interpretation</h3><p>Our findings suggested that COVID-19 is associated with an increased risk of developing various ADs and the risk could be attenuated by COVID-19 vaccination. Future studies investigating pathology and mechanisms would be valuable to interpreting our findings.</p><h3>Funding</h3><p>Supported by RGC Collaborative Research Fund (C7154-20GF).</p>-
dc.languageeng-
dc.publisherElsevier-
dc.relation.ispartofEClinicalMedicine-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectAutoimmune disorders-
dc.subjectCOVID-19 vaccine-
dc.subjectSARS-CoV-2-
dc.titleRisk of autoimmune diseases following COVID-19 and the potential protective effect from vaccination: a population-based cohort study-
dc.typeArticle-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1016/j.eclinm.2023.102154-
dc.identifier.scopuseid_2-s2.0-85167777152-
dc.identifier.volume63-
dc.identifier.eissn2589-5370-
dc.identifier.isiWOS:001058991800001-
dc.identifier.issnl2589-5370-

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