Severity of Acute SARS-CoV-2 Infection and Risk of New-Onset Autoimmune Disease: A RECOVER Initiative Study in Nationwide U.S. Cohorts

Simple item page
dc.contributorNational Institutes of Health
dc.contributor.authorWuller, Shannon
dc.contributor.otherNew York University Grossman School of Medicine
dc.date.accessioned2025-06-25T15:37:59Z
dc.descriptionSARS-CoV-2 infection has been associated with increased autoimmune disease risk. Past studies have not aligned regarding the most prevalent autoimmune diseases after infection, however. Furthermore, the relationship between infection severity and new autoimmune disease risk has not been well examined. This study used RECOVER’s electronic health record (EHR) networks, N3C, PCORnet, and PEDSnet, to estimate types and frequency of autoimmune diseases arising after SARS-CoV-2 infection and assessed how infection severity related to autoimmune disease risk. #### Cohort Description Identified patients of any age with SARS-CoV-2 infection between April 1, 2020 and April 1, 2021, and assigned them to a World Health Organization COVID-19 severity category for adults or the PEDSnet acute COVID-19 illness severity classification system for children (<age 21). Collected baseline covariates from the EHR in the year pre-index infection date and followed patients for 2 years for new autoimmune disease, defined as ≥ 2 new ICD-9, ICD-10, or SNOMED codes in the same concept set, starting >30 days after SARS-CoV-2 infection index date and occurring ≥1 day apart. Calculated overall and infection severity-stratified incidence ratesper 1000 person-years for all autoimmune diseases. With least severe COVID-19 severity as reference, survival analyses examined incident autoimmune disease risk. #### Results The most common new-onset autoimmune diseases in all networks were thyroid disease, psoriasis/psoriatic arthritis, and inflammatory bowel disease. Among adults, inflammatory arthritis was the most common, and Sjögren’s disease also had high incidence. Incident type 1 diabetes and hematological autoimmune diseases were specifically found in children. Across networks, after adjustment, patients with highest COVID-19 severity had highest risk for new autoimmune disease vs. those with least severe disease (N3C: adjusted Hazard Ratio, (aHR) 1.47 (95%CI 1.33–1.66); PCORnet aHR 1.14 (95%CI 1.02–1.26); PEDSnet: aHR 3.14 (95%CI 2.42–4.07)]. Overall, severe acute COVID-19 was most strongly associated with autoimmune disease risk in three EHR networks.
dc.description.abstractThis study aimed to investigate the association between SARS-CoV-2 infection and incident autoimmune diseases. The investigators examined COVID-19 severity and the risk of subsequently developing autoimmune disease among adults and children living across the U.S. within the Researching COVID-19 to Enhance Recovery (RECOVER) electronic health record (EHR) networks.
dc.identifier.urihttps://hdl.handle.net/20.500.14642/1142
dc.publisherPEDSnet
dc.relation.isreferencedbyWuller S, Singer NG, Lewis C, Karlson EW, Schulert GS, et al. (2025). "Severity of acute SARS-CoV-2 infection and risk of new-onset autoimmune disease: A RECOVER initiative study in nationwide U.S. cohorts." _PLOS ONE_ 20(6): e0324513. <br>DOI: [10.1371/journal.pone.0324513](https://doi.org/10.1371/journal.pone.0324513)
dc.rightsa CC-BY Attribution 4.0 license.
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectData Provenance::PEDSnet Data Source
dc.subjectResearch Methodology::Epidemiological Study
dc.subjectResearch Methodology::Epidemiological Study::Cohort Study
dc.subjectResearch Methodology::Epidemiological Study::Cohort Study::Prospective Study
dc.subject.meshCOVID-19
dc.subject.meshSARS-CoV-2
dc.subject.meshPost-Acute COVID-19 Syndrome
dc.subject.meshCoronavirus Infections
dc.subject.meshImmune System Diseases
dc.subject.meshAutoimmune Diseases
dc.titleSeverity of Acute SARS-CoV-2 Infection and Risk of New-Onset Autoimmune Disease: A RECOVER Initiative Study in Nationwide U.S. Cohorts
dspace.entity.typeStudy
local.subject.flatPEDSnet Data Source
local.subject.flatEpidemiological Study
local.subject.flatCohort Study
local.subject.flatProspective Study
local.subject.flatFederally Funded Research
project.endDate2025
relation.isStudyOfStudy4932bc8c-1f72-44ad-aeeb-b7922e38fad3
relation.isStudyOfStudy.latestForDiscovery4932bc8c-1f72-44ad-aeeb-b7922e38fad3

Files

Domains

RECOVER: Researching COVID to Enhance Recovery