Updated COVID ‐19 Vaccines and Health Outcomes in Patients With Autoimmune Rheumatic Conditions

OBJECTIVE: We aimed to assess the association between COVID-19 vaccination status and COVID-19-related hospital admissions, need for mechanical ventilation or extracorporeal membrane oxygenation (ECMO), and death in people with autoimmune rheumatic conditions. METHODS: We conducted a retrospective cohort study using National Clinical Cohort Collaborative (N3C) data on adults with autoimmune rheumatic conditions and incident COVID-19 occurring between December 2020 and August 2024. We assessed the association between COVID-19 vaccination status (unvaccinated, receipt of initial series, booster, or updated [2023-2024] vaccine) and COVID-19-related hospitalization (primary outcome), mechanical ventilation or ECMO, and death. Associations were estimated using mixed-effects logistic regression, adjusting for demographics, clinical risk, social vulnerability, and medications. RESULTS: Our cohort included 60,980 patients with rheumatic conditions (median age 62 years), of whom 46,043 (76%) were female and 44,876 (74%) were non-Hispanic White. Overall, 6,336 (10%) had received an updated (2023-2024) COVID-19 vaccine. Adjusted odds of hospitalization decreased progressively with vaccination (initial series adjusted odds ratio [aOR] 0.59 [95% confidence interval (CI) 0.56-0.63]; boosted series aOR 0.29 [95% CI 0.27-0.31]; and updated series aOR 0.31 [95% CI 0.28-0.34]) compared with no vaccine doses. Among patients who had received only the initial vaccine series versus a booster/updated vaccine, the absolute risk reduction was 5.6%. CONCLUSION: We observed decreased odds of COVID-19-related hospitalizations among patients with autoimmune rheumatic conditions who received an updated COVID-19 or booster vaccine compared to those who received the initial series alone or were unvaccinated. Updated vaccinations provide significant protection for this medically vulnerable population and should be supported by clinicians, policymakers, and patient advocacy groups.