Ashwini K Shetty, Madhavi Reddy, Nitin J Patil, E Senthil Kumaran, Pradeep Tarikere Satyanarayana, S R Sheela, A Raveesha, Vr Sudha Reddy, Gagan Bajaj
Development and validation of interprofessional health education module for the management of gestational diabetes mellitus
Journal of education and health promotion
context immunemediated inflammatory diseases imids covid19 outcomes incompletely understood vary considerably depending patient population studied aimed analyse severe covid19 outcomes investigate effects pandemic time period risks associated individual imids classes immunomodulatory medications imms chronic comorbidities covid19 vaccination status retrospective cohort study clinical data derived electronic health records integrated healthcare system serving patients 51 hospitals 1085 clinics across seven us states providence st joseph health data observed patients age restriction one imid unmatched controls without imids covid19 identified positive nucleic acid amplification test result sarscov2 two timeframes analysed march 1 2020dec 25 2021 preomicron period dec 26 2021aug 30 2022 omicronpredominant period primary outcomes hospitalisation mechanical ventilation mortality patients covid19 factors including imid diagnoses comorbidities longterm use imms covid19 vaccination status analysed multivariable logistic regression lr extreme gradient boosting xgb 2 167 656 patients tested sarscov2 290 855 134 confirmed covid19 15 397 53 patients imids 275 458 947 without imids preomicron period 169 993 112 1 517 295 people tested covid19 tested positive 23 330 137 hospitalised 1072 06 received mechanical ventilation 5294 31 died compared controls patients imids covid19 higher rates hospitalisation 1176 146 vs 22 154 137 p0024 mortality 314 39 vs 4980 31 p00001 omicronpredominant period 120 862 186 650 361 patients tested positive covid19 14 504 120 hospitalised 567 05 received mechanical ventilation 2001 17 died compared controls patients imids covid19 7327 173 42 249 higher rates hospitalisation 13 422 118 vs 1082 148 p00001 mortality 1814 16 vs 187 26 p00001 age risk factor worse outcomes adjusted odds ratio 21 95 ci 2021 p00001 30 2930 p00001 whereas covid19 vaccination 0082 00800085 p00001 052 050053 p00001 booster vaccination 21 2022 p00001 30 2930 p00001 status associated better outcomes seven chronic comorbidities significant risk factors time periods three outcomes atrial fibrillation coronary artery disease heart failure chronic kidney disease chronic obstructive pulmonary disease chronic liver disease cancer two imids asthma adjusted 033 032034 p00001 049 048051 p00001 psoriasis 052 048056 080 074087 p00001 associated reduced risk severe outcomes imid diagnoses appear significant risk factors results limited small sample size vasculitis high feature importance lr imms appear significant less frequently used imms limited sample size xgb outperformed lr area receiver operating characteristic curve models across different time periods outcomes ranging 077 092 results suggest age chronic comorbidities fully vaccinated might greater risk factors severe covid19 outcomes patients imids use imms imids overall need take age comorbidities consideration developing covid19 guidelines patients imids research needed specific imids including imid severity time sarscov2 infection imms considering dosage timing patients first covid19 infection pfizer novartis janssen national institutes health