Factors Associated with Mortality in Patients with Immune-Mediated Rheumatic Diseases and COVID-19 from Latin America

Objective To describe characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) from Argentina, Mexico and Brazil, and to assess factors associated with mortality in this population. Methods Data from 3 national registries, SAR-COVID (Argentina), CMR-COVID (Mexico), and ReumaCoV-Brasil (Brazil), were combined. Adult patients with IMIDs and SARS-CoV-2 infection were recruited. Sociodemographic data, comorbidities, IMID clinical characteristics and treatment, and SARS-CoV-2 infection presentation and outcomes were recorded. Results A total of 4827 individuals were included: 2542 (52.7%) from SAR-COVID, 1167 (24.2%) from CMR-COVID, and 1118 (23.1%) from ReumaCoV-Brasil. Overall, 82.1% were female with a mean age of 49.7 (SD, 14.3) years; 22.7% of the patients were hospitalized, and 5.3% died because of COVID-19 (coronavirus disease 2019). Argentina and Brazil had both 4% of mortality and Mexico 9.4%. In the multivariable analysis, older age (≥60 years; odds ratio [OR], 7.4; 95% confidence interval [CI], 4.6–12.4), male sex (OR, 1.5; 95% CI, 1.1–2.1), living in Mexico (OR, 3.0; 95% CI, 2.0–4.4), comorbidity count (1 comorbidity: OR, 1.5; 95% CI, 1.0–2.1), diagnosis of connective tissue disease or vasculitis (OR, 1.8; 95% CI, 1.3–2.4), and other diseases (OR, 2.6; 95% CI, 1.6–4.1) compared with inflammatory joint disease, high disease activity (OR, 4.2; 95% CI, 2.5–7.0), and treatment with glucocorticoids (OR, 1.9; 95% CI, 1.4–2.5) or rituximab (OR, 4.2; 95% CI, 2.7–6.6) were associated with mortality. Conclusions Mortality in patients with IMIDs was particularly high in Mexicans. Ethnic, environmental, societal factors, and different COVID-19 mitigation measures adopted have probably influenced these results.