Alice Fike, MS, NP: Latino Patients Disproportionately Affected by COVID-19

Rheumatology Network recently covered a study titled “Risk factors for COVID-19 and rheumatic disease flare in a US cohort of Latino patients.” The primary objective of this retrospective study was to understand why Latino patients were being disproportionately affected by coronavirus disease 2019 (COVID-19). Of the patients observed, 18% developed COVID-19 during the study period, meaning incidence rates were 5- to 11-fold higher than the general population. Investigators discovered that Latino patients had a greater chance of being exposed to and contracting the illness due to higher rates of obesity and sociodemographic factors. Further, Latino patients with rheumatic diseases are at an even greater disadvantage as viral infections, like COVID-19, have been shown to trigger rheumatic disease flares.

This week, we sat down for an interview with Alice Fike, MS, NP, from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), to discuss her interpretation of the data and her team’s plans for future studies.

Rheumatology Network: Hi, Ms. Fike. Thank you for joining me. So, to get started, what initially sparked your team's interest in comparing the COVID-19 exposure and outcomes of the Latino population with the general population?

Alice Fike: Well, thank you for having me. Here at the NIH, we have a core group of patients in one of our natural history studies we follow for various rheumatic diseases and the majority of those patients are Latino. And we did notice, as the pandemic started, that we were having a good amount of cases in our patient population. And we wanted to see how health disparities related to COVID were emerging. Were there any differences with respect to our population being that they suffer from rheumatic diseases?

RN: Were you surprised by the results of this study?

AF: I don't, I would say definitely, we're not surprised by the incidence, because our patients within this cohort, they generally- almost all of them are frontline workers, or they are household members or frontline workers. So, their baseline risk for COVID is already quite high. That's how they earn their living. And most of them, you know, they're in hourly, low-wage jobs that don't provide for sick leave or working from home. So, you know, that puts them at really high risk.

RN: Of the patients who developed COVID-19 in your study, 91% were female. Why do you think women were so much more susceptible to the Coronavirus in your cohort?

AF: So, 91% of the patients who reported COVID within our cohort were women. However, I will say that 80% of our cohort are women. I think it reflects the makeup of our cohort, I would say. It is different from other larger registries that have been reported, which have reported higher percentages of men. And then we know that male gender is a risk factor for more severe COVID disease. So that might be one of the explanations as to why our cohort had relatively mild disease.

RN: Yes, that was actually my next question. Because another interesting factor of your study was that none of the positive patients had particularly severe outcomes. And I read that other studies have inferred that Latino patients, and people with rheumatic disease in general, develop more severe symptoms. I was going to ask you why you believe that was not the case for this study.

AF: Why COVID disease was relatively mild and our patient population? We did have 6 patients who were hospitalized. A couple of those patients needed supplemental oxygen, but nobody had to be admitted to ICU. There were no patients who needed mechanical ventilation. And we didn't we haven't had any deaths in our cohort to date, which is great. So, I think a couple reasons. One is our cohort is predominantly women and men are at higher risk for more severe outcomes. So, I think that shifts a little bit. Another factor in our cohort is our patients are relatively young. Our mean age for the cohort overall, is about 50 years old. And for this group of patients, it's more around 45 to 50 years old. So, I think that probably played a role. Additionally, our patients, they don't have a lot in the way of additional comorbidities to the extent of some of the other groups of patients that have been reported and not as many risk factors that have been reported for more severe COVID outcomes.

RN: Besides BMI, and the fact that all COVID-positive patients were either essential workers, or had essential workers in their households, are there any other risk factors that you had observed and believed to be worth noting?

AF: Honestly, I think what explains in terms of risk factors for getting COVID and our patient population, I think we did see increased. We tried to compare to Latino residents of the general population, in the general area, Latino residents of the greater DC area, and we did find that our patients had a higher incidence even compared to Latino patients. And so that could be a couple of things at play. And I think, you know, we need more study to understand it better. It could be that there is something about patients with rheumatic diseases that makes them more susceptible that we haven't, that we don't quite understand yet. It could also be that our patient population is really just more at risk due to the nature of most of their occupation, in terms of having to be out in flatline. Whereas the general Latino population in this area might not be that, you know, 100% of them have to be out there in public, to earn a living or are a member of the household. Whereas in our patient population, it really was 100% of our patients who were at that level of risk.

RN: And as you were saying, even though this was a relatively small patient population observed in a specific area, do you believe that the results of the study can be applied to the country as a whole? Or is this more representative of cities like Washington, DC?

AF: I think in terms of generalizability, I think that our findings probably are similar to or could be applied to other urban Latino groups of patients of similar socioeconomic background. My feeling is that the strongest risk factor for these patients in terms of getting COVID is their occupation and also their living arrangements. If they're not a frontline worker themselves, they are a member of a household, where another frontline worker also lives. Or where they live in multi-generational housing where the likelihood of somebody within a multi-generational household having to be a frontline worker is even more increased.

RN: Does your team plan on doing any further research on this topic?

AF: Yes, actually, we are. We're opening a perspective study. And this will be with not just our group, but it will be across several groups within National Institute of Arthritis, Musculoskeletal and Skin Diseases. We're going to look at the effects of COVID illness and/or immunization on patients with autoimmune rheumatic diseases. And so we'll look at the patients before they either are vaccinated or get COVID and then look at them after to see we can understand better mechanistically what's happening and if we can explain why certain patients seem to be more susceptible than others. This is a study that's led by Dr. Mariana Kaplan.

RN:Is there anything else that you would like to add before we wrap things up?

AF: I don't think so.

RN: Well, I appreciate you taking the time to speak with me today. Thank you very much.

AF: Okay. Thanks so much for having me.