LAUSR

Purpose To identify if non-infectious 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 three years prior to January 20, 2020. Patients with an NIU diagnosis within three 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 hazards models were used to identify unadjusted hazard ratios as well as adjusted hazard ratios 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 which 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. 4.2%, 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 (hazard ratio [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 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 to NIU alone. Patients utilizing 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.