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We assessed the association between COVID\u201019 vaccination status (unvaccinated, receipt of initial series, booster, or updated [2023\u20132024] vaccine) and COVID\u201019\u2010related hospitalization (primary outcome), mechanical ventilation or ECMO, and death. Associations were estimated using mixed\u2010effects logistic regression, adjusting for demographics, clinical risk, social vulnerability, and medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2010Hispanic White. Overall, 6,336 (10%) had received an updated (2023\u20132024) COVID\u201019 vaccine. Adjusted odds of hospitalization decreased progressively with vaccination (initial series adjusted odds ratio [aOR] 0.59 [95% confidence interval (CI) 0.56\u20130.63]; boosted series aOR 0.29 [95% CI 0.27\u20130.31]; and updated series aOR 0.31 [95% CI 0.28\u20130.34]) 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%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We observed decreased odds of COVID\u201019\u2010related hospitalizations among patients with autoimmune rheumatic conditions who received an updated COVID\u201019 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.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/art70290-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.70290","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T07:01:23Z","timestamp":1788937283000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Updated\n                    <scp>COVID<\/scp>\n                    \u201019 Vaccines and Health Outcomes in Patients With Autoimmune Rheumatic Conditions"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9373-7620","authenticated-orcid":false,"given":"Lesley E.","family":"Jackson","sequence":"first","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Medicine University of Alabama at Birmingham"},{"name":"Rheumatology Birmingham VA Medical Center  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-7845","authenticated-orcid":false,"given":"A. Jerrod","family":"Anzalone","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth G.","family":"Saag","sequence":"additional","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Medicine University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6559-9012","authenticated-orcid":false,"given":"Rahima","family":"Begum","sequence":"additional","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Medicine University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AKM F.","family":"Rahman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namrata","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Rheumatology University of Washington Medical Center  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3485-0006","authenticated-orcid":false,"given":"Jasvinder A.","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Medicine University of Alabama at Birmingham"},{"name":"Medicine Service, Michael E. 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