Influence of Outpatient Clinic Visits on Receipt of the COVID-19 Vaccine Among People With Autoimmune Rheumatic Diseases

Clinicians are trusted sources for health advice for people living with autoimmune rheumatic diseases (AIRD), and they may influence the vaccine decision-making during outpatient visits. We aimed to determine factors associated with receipt of a COVID-19 vaccine during the immediate follow-up interval after rheumatology or primary care provider (PCP) clinic visits.

We used the electronic health record (EHR) to conduct a retrospective cohort study of established patients with AIRD at our institution. The primary outcome was presence/absence of COVID-19 vaccination during the 8-day interval after a rheumatology or a PCP clinic visit. We built multivariable logistic regression models to identify factors independently associated vaccine receipt post-visit. We conducted a self-controlled case series (SCCS) analysis to compare receipt of COVID-19 vaccination during the 8- days post-visit “hazard interval” vs. 8-days pre-visit “control interval” as a sensitivity analysis.

We identified 2,628 individuals with 2+ rheumatology clinic visits and 493 individuals with 2+ PCP clinic visits, of whom 440 (16.7%) and 119 (24.1%) received a COVID-19 vaccine in the 8-day post-visit interval, respectively. In the multivariable logistic regression model of those with rheumatology visits, older age (OR=1.17, 95% CI 1.03 – 1.33, p=0.02,), Black race (OR=1.49, 95% CI 1.15 – 1.92, p=0.002), and use of glucocorticoids (OR=1.63, 95% CI 1.25 – 2.14, p=0.0004), immunosuppressive (OR=1.40, 95% CI 1.03 – 1.88, p=0.03) medications, and intravenous immunoglobulin (OR=1.91, 95% CI 1.16 – 3.16, p=0.01) were associated with higher odds of COVID-19 vaccination events. Among those with 2+ PCP clinic visits, only older age (OR=1.58, 95% CI 1.22 – 2.06, p=0.0006) and Black race (OR=1.70, 95% CI 1.06 – 2.72, p=0.03) were associated with a post-visit vaccine event. In the SCCS analysis, there were significantly higher rates of vaccination events during the post-visit hazard interval for rheumatology (IRR=1.87, 95% CI 1.62 – 2.18, p<0.0001) and PCP (IRR=3.81, 95% CI 2.75 – 5.36, p<0.0001). 

In this cohort study of diverse individuals with AIRDs, we found that age, race, and use of certain high-risk medications were associated with COVID-19 vaccination in the post-visit interval. Effective interventions aimed at improving vaccine uptake could be implemented at or soon after a clinic visit.