Elsevier

Ophthalmology

Volume 129, Issue 3, March 2022, Pages 334-343
Ophthalmology

Original Article
The Association between Noninfectious Uveitis and Coronavirus Disease 2019 Outcomes: An Analysis of United States Claims-Based Data

https://doi.org/10.1016/j.ophtha.2021.10.007Get rights and content

Purpose

To identify if noninfectious uveitis (NIU) is associated with a greater risk of Coronavirus Disease 2019 (COVID-19) infection, hospitalization, and death.

Design

A retrospective cohort study from January 20, 2020 to December 31, 2020, using a national claims-based database.

Participants

Enrollees who had continuous enrollment with both medical and pharmacy coverage for 3 years before January 20, 2020. Patients with an NIU diagnosis within 3 years of the start of the study were included in the NIU cohort. Those with infectious uveitis codes or new NIU diagnoses during the risk period were excluded.

Methods

Cox proportional hazard models were used to identify unadjusted hazard ratios (HRs) and adjusted HRs for all covariates for each outcome measure. Adjusted models accounted for patient demographics, health status, and immunosuppressive medication use during the risk period.

Main Outcome Measures

Rates of COVID-19 infection, COVID-19-related hospitalization, and COVID-19-related in-hospital death identified with International Classification of Disease 10th revision codes.

Results

This study included 5 806 227 patients, of whom 29 869 (0.5%) had a diagnosis of NIU. On unadjusted analysis, patients with NIU had a higher rate of COVID-19 infection (5.7% vs. 4.5%, P < 0.001), COVID-19-related hospitalization (1.2% vs. 0.6%, P < 0.001), and COVID-19-related death (0.3% vs. 0.1%, P < 0.001). However, in adjusted models, NIU was not associated with a greater risk of COVID-19 infection (HR, 1.05; 95% confidence interval [CI], 1.00–1.10; P = 0.04), hospitalization (HR, 0.98; 95% CI, 0.88–1.09; P = 0.67), or death (HR, 0.90, 95% CI, 0.72–1.13, P = 0.37). Use of systemic corticosteroids was significantly associated with a higher risk of COVID-19 infection, hospitalization, and death.

Conclusions

Patients with NIU were significantly more likely to be infected with COVID-19 and experience severe disease outcomes. However, this association was due to the demographics, comorbidities, and medications of patients with NIU, rather than NIU alone. Patients using systemic corticosteroids were significantly more likely to be infected with COVID-19 and were at greater risk of hospitalization and in-hospital death. Additional investigation is necessary to identify the impact of corticosteroid exposure on COVID-19-related outcomes.

Keywords

Corticosteroids
COVID-19
COVID-19 deaths
COVID-19 hospitalizations
Noninfectious uveitis

Abbreviations and Acronyms

CI
confidence interval
COVID-19
Coronavirus Disease 2019
DMARD
disease-modifying anti-rheumatic drug
HR
hazard ratio
ICD-10
International Classification of Disease 10th Revision
NIU
noninfectious uveitis
OLDW
OptumLabs Data Warehouse
SD
standard deviation
TNF-α
tumor necrosis factor alpha

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Supplemental material available at www.aaojournal.org.

Disclosure(s): All authors have completed and submitted the ICMJE disclosures form.

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Supported by the National Eye Institute and Office of Research on Women’s Health at the National Institutes of Health (grant no. R01 EY028739, to Principal Investigator N.R.A.) and an OptumLabs Data Warehouse research credit.

HUMAN SUBJECTS: Human subjects were not included in this study. The human ethics committees at the University of California, San Francisco approved the study. All research adhered to the tenets of the Declaration of Helsinki. The requirement for informed consent was waived because of the retrospective nature of the study.

No animal subjects were used in this study.

Author Contributions:

Conception and design: Miller, Sun, Acharya

Data collection: Miller, Sun, Chen, Acharya

Analysis and interpretation: Miller, Sun, Arnold, Acharya

Obtained funding: Acharya

Overall responsibility: Miller, Sun, Chen, Arnold, Acharya

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