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• Correspondence to 'Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study' by Bower et al.
  Pei-En Kao, I-Kuan Wu, Jung Chi Chiang, Amy Ker and James Cheng-Chung Wei
  Published on: 24 August 2021

• Published on: 24 August 2021

  Correspondence to 'Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study' by Bower et al.

  • Pei-En Kao, college student School of Medicine, Chung Shan Medical University
  • Other Contributors:
    • I-Kuan Wu, college student
    • Jung Chi Chiang, college student
    • Amy Ker, college student
    • James Cheng-Chung Wei, Rheumatologists

  Article type: Letter to the Editor

  Correspondence to 'Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study' by Bower et al.

  Authors:
  Pei-En Kao1, I-Kuan Wu1, Jung Chi Chiang1, Amy Ker1, James Cheng-Chung Wei, MD, PhD.2,3,4
  Affiliations:
  1 School of Medicine, Chung Shan Medical University
  2 Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital
  3 Institute of Medicine, College of Medicine, Chung Shan Medical University
  4 Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.

  Correspondence author:
  James Cheng-Chung Wei, MD, PhD.
  No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan. (TEL)＋
  886 4 24739595 #34718.
  E-mail: jccwei@gmail.com

  Conflicts of interest: None to declare

  Funding acknowledgement: Not applicable.

  Total word count: 311 words, table: 0
   
  With great interest, we read the article of Bower et al investigating whether patients with inflammatory joint disease (IJDs) is associated with the different all-cause mortality and COVID-19-related outcomes.1 However, some points need to be discussed.
  First and foremost, we notice that there are other unmeasured factors such as occupation and smoking s...

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  Article type: Letter to the Editor

  Correspondence to 'Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study' by Bower et al.

  Authors:
  Pei-En Kao1, I-Kuan Wu1, Jung Chi Chiang1, Amy Ker1, James Cheng-Chung Wei, MD, PhD.2,3,4
  Affiliations:
  1 School of Medicine, Chung Shan Medical University
  2 Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital
  3 Institute of Medicine, College of Medicine, Chung Shan Medical University
  4 Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.

  Correspondence author:
  James Cheng-Chung Wei, MD, PhD.
  No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City 40201, Taiwan. (TEL)＋
  886 4 24739595 #34718.
  E-mail: jccwei@gmail.com

  Conflicts of interest: None to declare

  Funding acknowledgement: Not applicable.

  Total word count: 311 words, table: 0
   
  With great interest, we read the article of Bower et al investigating whether patients with inflammatory joint disease (IJDs) is associated with the different all-cause mortality and COVID-19-related outcomes.1 However, some points need to be discussed.
  First and foremost, we notice that there are other unmeasured factors such as occupation and smoking status having not been adjusted or discussed, which may cause residual confounding. Regarding to the aspect of occupation, some certain occupations are more likely to expose to COVID‐19 compared with others. Mutambudzi et al study has revealed that healthcare workers, social and education workers had an increased risk of severe COVID-19.2 Additionally, there are more and more studies demonstrating that the smokers have a higher risk of severe symptoms of COVID-19 and death compared to non-smokers. Patanavanich et al study has reported that smoking is an independent risk factor for having COVID-19 disease progression and mortality.3 Therefore, we are convinced that taking occupation and smoking status into account would minimize the residual confounding.
  Secondly, according to the Bowel et al study, asymptomatic COVID-19 patients or covid-19 patients tested in false-negative should be brought into discussion. A previous study has revealed that 40% to 45% of SARS-CoV-2 infected persons are asymptomatic.4 In Wiersinga et al study, it has presented that up to 20% to 67% patients’ test results are false-negative.5 Consequently, the number of the actual COVID-19 patients would be underestimated. For the sake of study accuracy, asymptomatic COVID-19 patients or COVID-19 patients tested in false-negative are suggested to be taken into consideration.
  Finally, in Bowel et al study, the two open cohorts, RA cohort and other IJD cohort, included individuals all prevalent RA and other IJDs respectively from March 2015 through September 2020. However, the details of method for selecting two open cohorts above are not mentioned in the article and therefore potential selection bias might not be excluded.

  References:
  1. Bower H, Frisell T, Di Giuseppe D, et al. Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study. Ann Rheum Dis 2021;80(8):1086-93. doi: 10.1136/annrheumdis-2021-219845 [published Online First: 2021/02/25]
  2. Mutambudzi M, Niedzwiedz C, Macdonald EB, et al. Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occupational and Environmental Medicine 2021;78(5):307. doi: 10.1136/oemed-2020-106731
  3. Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: a systematic review and meta-analysis. BMC Public Health 2021;21(1):1554. doi: 10.1186/s12889-021-11579-x
  4. Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection : A Narrative Review. Ann Intern Med 2020;173(5):362-67. doi: 10.7326/m20-3012 [published Online First: 2020/06/04]
  5. Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. Jama 2020;324(8):782-93. doi: 10.1001/jama.2020.12839 [published Online First: 2020/07/11]

  Correspondence to James Cheng-Chung Wei, MD, PhD; jccwei@gmail.com
  Acknowledgements None declared.
  Contributors All authors (PEK, IKW, JCC, AK,and JCW) provided their ideas and critical contribution. PEK, IKW, JCC, AK and JCW contributed to the editing of the manuscript.
  Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for profit sectors.
  Competing interests The authors declare no conflict of interest.
  Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
  Patient consent for publication Not required.
  Provenance and peer review Not commissioned; internally peer reviewed.
  Ethical approval information Not required.
  Data sharing statement Not required.

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  Conflict of Interest:
  None declared.

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