Incident autoimmune diseases in association with SARS-CoV-2 infection: a matched cohort study

Research output: Contribution to journalResearch articleContributedpeer-review


  • Falko Tesch - , Center for Evidence-Based Healthcare (First author)
  • Franz Ehm - , Center for Evidence-Based Healthcare (Author)
  • Annika Vivirito - , InGef - Institute for Applied Health Research Berlin GmbH (Author)
  • Danny Wende - , BARMER Institut für Gesundheitssystemforschung (bifg) (Author)
  • Manuel Batram - , Vandage GmbH (Author)
  • Friedrich Loser - , Techniker Krankenkasse (Author)
  • Simone Menzer - , IKK classic (Author)
  • Josephine Jacob - , InGef - Institute for Applied Health Research Berlin GmbH (Author)
  • Martin Roessler - , Center for Evidence-Based Healthcare (Author)
  • Martin Seifert - , Center for Evidence-Based Healthcare (Author)
  • Barbara Kind - , Center for Evidence-Based Healthcare (Author)
  • Christina König - , Techniker Krankenkasse (Author)
  • Claudia Schulte - , BARMER Institut für Gesundheitssystemforschung (bifg) (Author)
  • Tilo Buschmann - , AOK PLUS (Author)
  • Dagmar Hertle - , BARMER Institut für Gesundheitssystemforschung (bifg) (Author)
  • Pedro Ballesteros - , BARMER Institut für Gesundheitssystemforschung (bifg) (Author)
  • Stefan Baßler - , AOK PLUS (Author)
  • Barbara Bertele - , Techniker Krankenkasse (Author)
  • Thomas Bitterer - , IKK classic (Author)
  • Cordula Riederer - , DAK-Gesundheit (Author)
  • Franziska Sobik - , DAK-Gesundheit (Author)
  • Lukas Reitzle - , Robert Koch-Institut (Author)
  • Christa Scheidt-Nave - , Robert Koch-Institut (Author)
  • Jochen Schmitt - , Center for Evidence-Based Healthcare (Last author)


OBJECTIVES: To investigate whether the risk of developing an incident autoimmune disease is increased in patients with prior COVID-19 disease compared to those without COVID-19, a large cohort study was conducted.

METHOD: A cohort was selected from German routine health care data. Based on documented diagnoses, we identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through December 31, 2020. Patients were matched 1:3 to control patients without COVID-19. Both groups were followed up until June 30, 2021. We used the four quarters preceding the index date until the end of follow-up to analyze the onset of autoimmune diseases during the post-acute period. Incidence rates (IR) per 1000 person-years were calculated for each outcome and patient group. Poisson models were deployed to estimate the incidence rate ratios (IRRs) of developing an autoimmune disease conditional on a preceding diagnosis of COVID-19.

RESULTS: In total, 641,704 patients with COVID-19 were included. Comparing the incidence rates in the COVID-19 (IR=15.05, 95% CI: 14.69-15.42) and matched control groups (IR=10.55, 95% CI: 10.25-10.86), we found a 42.63% higher likelihood of acquiring autoimmunity for patients who had suffered from COVID-19. This estimate was similar for common autoimmune diseases, such as Hashimoto thyroiditis, rheumatoid arthritis, or Sjögren syndrome. The highest IRR was observed for autoimmune diseases of the vasculitis group. Patients with a more severe course of COVID-19 were at a greater risk for incident autoimmune disease.

CONCLUSIONS: SARS-CoV-2 infection is associated with an increased risk of developing new-onset autoimmune diseases after the acute phase of infection. Key Points • In the 3 to 15 months after acute infection, patients who had suffered from COVID-19 had a 43% (95% CI: 37-48%) higher likelihood of developing a first-onset autoimmune disease, meaning an absolute increase in incidence of 4.50 per 1000 person-years over the control group. • COVID-19 showed the strongest association with vascular autoimmune diseases.


Original languageEnglish
Pages (from-to)2905-2914
Number of pages10
JournalClinical rheumatology
Issue number10
Publication statusPublished - Oct 2023

External IDs

PubMedCentral PMC10497688
Scopus 85162221614
WOS 001014957300001
Mendeley 61fe9afd-d010-3a7b-add4-7eac2bf656d6


DFG Classification of Subject Areas according to Review Boards

ASJC Scopus subject areas


  • Humans, COVID-19/epidemiology, SARS-CoV-2, Cohort Studies, Autoimmune Diseases/complications, Arthritis, Rheumatoid, Covid-19, Claims data, Cohort study, Autoimmune diseases, COVID-19