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We read with great interest the recent paper “Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry” published in the Annals by Strangfeld et al.1
Given the current epidemiological situation, all evidence indicate that the best option for preventing both morbidity and mortality in the initial phase of the COVID-19 vaccination programme is to directly protect persons who are most at risk. Based on the author’s findings,1 and previously published data,2 not all patients with rheumatic disease are at increased risk of severe COVID-19 and COVID-19-related death. We believe the data reported in Strangfeld et al1 can be further expanded to allow the calculation of individual risk scores of COVID-19-related death, which in turn could be used to prioritise patients with rheumatic diseases at highest risk within national and European policies on COVID-19 vaccination.
The use of the multivariate logistic regression model allows to establish a relationship between the binary outcome variable (COVID-19-related death, Yes or No) and a group of predictor variables (demographic characteristics, underlying disease, medications, etc) in such a way that logit of the probability of death due to COVID-19 is directly related to the regression coefficients of the model (as logit(probability of death) = β0 + β1 * Risk factor1 + … + βx * Risk factorx, with β0 being the regression coefficient of the intercept of the model). The detailed knowledge of the ORs associated with individual risk factors (as reported in Strangfeld et al1) allows the calculation of the overall increase in the risk of COVID-19-related death for a patient with rheumatic disease with versus without those risk factors.
However, additional knowledge of the estimate of the intercept of the model (which is not reported in Strangfeld et al1) would allow further estimation of the individual probability of death due to COVID-19, and the derivation of risk scores for COVID-19-related death of patients with rheumatic disease. These additional analyses could be used for detailed risk stratification with tremendous expected impact on patient prioritisation within national and European policies on COVID-19 vaccination.
Contributors LA and HD wrote the manuscript and approved the final version.
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 None declared.
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.
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