Impact of COVID-19 on the management of autoimmune disease in Sweden

Abstract

Objective: To determine the extent and nature of changes in healthcare resource use and deaths during the COVID-19 pandemic of patients with multiple sclerosis (MS) or rheumatoid arthritis (RA) in Sweden, with a focus on digital events and planned visits. Methods: Patients had a main diagnosis of MS or RA between 2014-2020 (“incident”) or 1987-2020 (“prevalent”). Retrospective aggregate data were obtained from the National Patient Register on patient characteristics, number of in- and outpatient events in specialised healthcare, planned visits, digital events, inpatient admissions, and length of stay for overnight admissions in each study period. From the Cause of Death Register, the number and top causes of death were obtained for patients in each study period, as well as the number with COVID-19 as an underlying cause of death. Healthcare use during the COVID-19 pandemic was observed for 7 months in 2020, and equivalent annual study periods between 2014-2019 were used to determine normal variation. Results: Compared to normal annual variation, specialised healthcare use by MS and RA incident patients did not change during 2020. However, the number of planned inpatient visits decreased, and number of digital outpatient visits significantly increased (P>0.005) for both diseases. The number of deaths was not notably different in the COVID-19 study period, although COVID-19 was found to be one of the most common causes of death in RA patients in 2020. Conclusions: This study provides evidence of MS and RA patients’ healthcare resource use in Sweden during the COVID-19 pandemic, and the results suggest that whilst the use of specialised healthcare has remained fairly unchanged, patients appear to have avoided physical visits and instead migrated towards digital visits. Further research is needed to explore the long-term effects of the pandemic on healthcare resource use in order to strengthen these conclusions.