Gender differences on the impact of the covid-19 pandemic and lockdown in patients with rheumatic diseases. results from the reumavid study (phase 1)

Background: The COVID-19 pandemic has impacted health, lifestyle, treatment and healthcare of European patients with rheumatic and musculoskeletal diseases (RMDs). Objectives: The aim is to evaluate gender differences on the impact of the first wave of the COVID-19 pandemic in the wellbeing, life habits, treatment, and healthcare access of European patients with RMDs. Methods: REUMAVID is an international collaboration led by the Health & Territory Research at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs, recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom during the first phase of the pandemic (April-July 2020). Mann-Whitney and χ 2 tests were used to analyse differences between gender regarding sociodemographic characteristics, life style, treatment, healthcare, and patient-reported outcomes. Results: 1,797 patients were included in this analysis. 80.2% were female and a mean age of 52.6 years. The most common diagnosis was inflammatory arthritis (81.7% male vs 73.8% female). There was a higher prevalence of fibromyalgia among females (20% vs 7.0% male). Overall, females reported worse self-perceived health (67.0% vs 51.4%, p<0.001), higher risk of anxiety (59.5% vs 48.1%, p<0.001), and depression (48.0% vs 37.2%, p<0.001). Females reported a greater increase in smoking (26.5% vs 17.5%, p=0.001), although they were less likely to drink alcohol (34.5% vs 25.4%, p=0.013), and also engaged less in physical activity (53.0% vs 60.3%, p=0.045). Overall, females were more likely to keep their scheduled rheumatology appointment (43.3% vs 34.1% of males (p=0.049; Table 1) with a higher proportion of females having their rheumatic treatment changed (17.0% vs 10.7%, p=0.005). Conclusion: The first wave of the COVID-19 pandemic and the containment measures have worsened self-perceived health status of patients with RMDs, affecting genders differently. Females reported worse psychological health and life habits such as increased smoking and reduced physical activity, while males increased their alcohol consumption and were less likely to attend their rheumatology appointments. Table 1. Bivariate analysis by gender (N= 1,797 unless specify) Mean ± SD or n (% ) P- value Male (N= 355) Female (N= 1,442) Sociodemographic characteristics Disease Inflammatory arthritis 1 290 (81.7) 1,064 (73.8) Fibromyalgia 25 (7.0) 287 (19.9) Connective tissue disease 2 18 (5.1) 195 (13.5) Osteoarthritis 52 (14.6) 255 (17.7) Osteoporosis 10 (2.8) 104 (7.2) Vasculitis 3 7 (2.0) 29 (2.0) SAPHO 1 (0.3) 14 (1.0) Age, years 52.8 ± 14.2 52.5 ± 12.9 0.896 Educational level University 162 (45.6) 711 (49.3) 0.215 Marital status Married or in relationship 269 (75.8) 983 (68.2) 0.002* Member of a Patient organisation, N=1,795 Yes 188 (53.0) 559 (38.8) <0.001* Patient-reported outcomes HADS Anxiety, N=1,766 Risk 168 (48.1) 843 (59.5) <0.001* HADS Depression, N=1,766 Risk 130 (37.2) 680 (48.0) <0.001* Wellbeing, N=1,774 WHO-5 ≤ 50 188 (53.4) 681 (47.9) 0.064 Self-perceived health, N=1,783 Fair or bad 182 (51.4) 958 (67.0) <0.001* Change in health status during COVID-19 pandemic, N=1,783 Worse 333 (94.1) 1,339 (93.7) 0.799 Life style during COVID-19 pandemic Smoking, N=555 More than before 20 (17.5) 117 (26.5) 0.001* Alcohol consumption, N=1,083 Quit drinking 71 (25.4) 277 (34.5) 0.013 Physical activity, N=1,126 Yes 144 (60.3) 470 (53.0) 0.045* Treatment and healthcare Able to meet rheumatologist, N= 721 No 89 (65.9) 332 (56.7) 0.049* Access to GP, N=688 No 43 (39.4) 248 (42.8) 0.512 1 Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2 Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3 Including: Polymyalgia Rheumatic and Vasculitis or Arteritis. Acknowledgements: This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom. Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, LAURENT GRANGE: None declared, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB., Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB