Background: Immunocompromised patients were excluded from the trials testing the efficacy of the COVID-19 vaccination. To inform clinical practice guidelines, we searched for studies evaluating COVID-19 vaccines in people with autoimmune inflammatory rheumatic diseases (AIRDs). Objective: We examined how populations experiencing inequities were considered in studies of COVID-19 vaccination in individuals with AIRDs.
Methods: We included 19 studies from an ongoing Cochrane living review on COVID-19 vaccination in people with AIRDs. We used the PROGRESS-Plus framework (place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, and social capital, plus: age, multimorbidity, and health literacy) to analyze the included populations. We assessed differences in COVID-19 baseline risk, eligibility, description of participant characteristics, and attrition, controlling for confounding factors, subgroup analyses, and applicability of findings.
Results: All 19 studies were cohort studies that followed individuals with AIRDs after vaccination. Three studies (16%) described differences in baseline risk for COVID-19 across age. Two studies (11%) defined eligibility criteria based on occupation and age. All 19 studies described participant age and sex. Twelve studies (67%) controlled for age and/or sex as confounders. Eight studies (47%) conducted subgroup analyses across at least one PROGRESS-Plus factor, most commonly age. Ten studies (53%) interpreted applicability in relation to at least one PROGRESS-Plus factor, most commonly age (47%), followed by ethnicity (16%), sex (16%), and multimorbidity (11%).
Conclusions: Sex and age were the most frequently considered PROGRESS-Plus factors in studies of COVID-19 vaccination in individuals with AIRDs. The generalizability of evidence to populations experiencing inequities is uncertain. Future COVID-19 vaccine studies should report participant characteristics in more detail to help inform the applicability of findings. Patient, public, and/or healthcare consumer involvement: None for this project. Wang H, Dewidar O, Whittle SL, Ghogomu E, Hazlewood G, Leder K, Mbuagbaw L, Pardo Pardo J, Robinson PC, Buchbinder R, Welch V. Equity Considerations in COVID-19 Vaccination Studies of Individuals With Autoimmune Inflammatory Rheumatic Diseases. Arthritis Care Res (Hoboken). 2022 Oct 4:10.1002/acr.25034. doi: 10.1002/acr.25034.