Background/Purpose: Similar to other rheumatic disorders, patients with spondyloarthritis (SpA) show an increased prevalence of comorbidities compared to the general population [1]. Comorbidities influence management, prognosis and quality of life of SpA patients [2], but their impact on the utilization of health resources has been scantly explored so far.
Methods: The emAR II was a descriptive, multi-center, cross-sectional study, performed in Spain between 2009 and 2010. The records of patients with a SpA diagnosis plus at least a visit to the Rheumatology department within the previous two years were selected using an equiprobabilistic method. Health care utilization was collected during the previous 2-year period as: a) hospital admissions; b) visits to the rheumatology clinics; c) referrals to other medical specialists by the rheumatologist; and d) diagnostic procedures ordered due to SpA. The following comorbidities were registered: hypertension, diabetes, coronary heart disease, chronic heart failure, stroke, neoplasm, infections, peptic ulcer disease, chronic kidney disease, liver disease, and anticoagulation therapy. Additional descriptive and confounding variables were collected. Association between use of resources and comorbidities was assessed by lineal regression for continuous variables and logistic regression for binary variables, accounting for Poisson distribution.
Results: 1,168 patients’ records from 45 centres were reviewed in detail (recruitment rate: 73%), mean (±SD) age 50.1 (±13.8) years. 68% males. Main SpA forms were ankylosing spondylitis and psoriatic arthritis. The use of resources was as follows: 248 admissions in 196 patients (19.2%, rate 12.1 per 100 patient-years), 5908 visits to rheumatology clinics (median (IQR) 4 visits per patient (3-6), rate 254 per 100 patient-years), 844 referrals to other specialists (rate 200 per 100 patient-years), and 85560 diagnostic procedures (rate 1753 per 100 patient-years). Analysis results are shown in Table 1. Hypertension, diabetes, coronary heart disease, chronic heart failure, infections, neoplasms, chronic kidney disease, and anticoagulation showed a positive, significant association with hospital admissions. The occurrence of infections was the only comorbidity significantly associated to visits, while no comorbidity showed a significant association to referrals. Infections and neoplasms were significantly associated to the diagnostic procedures.
Conclusion: Comorbidities in SpA influence health resources utilization, except for referrals to other specialties. This finding, added to the known impact in other areas of the disease, makes the identification of comorbidities advisable.
References: [1] J Rheumatol; 33:2167. [2] Rheum Dis Clin North Am 2012; 38:523.
Table 1.
|
|
Association between comorbidities and health resources utilization (univariate analysis). |
||||
|
|
N (%) |
Admissions (OR;95%CI) |
Visits (b; 95%CI) |
Referrals (OR; 95%CI) |
Diagnostic Procedures (b; 95%CI) |
|
Hypertension |
203 (17.4) |
2.563 (1.789-3.673) |
-0.152 (-0.835,0.530) |
1.023 (0.709-1.477) |
0.600 (-2.613,3.813) |
|
Diabetes |
71 (6.1) |
1.883 (1.059-3.348) |
-0.259 (-1.341,0.824) |
1.622 (0.905-2.907) |
3.614 (-1.477,8.7006) |
|
Coronary heart disease |
41 (3.5) |
6.472 (3.271-12.806) |
-1.355 (-2.758,0.049) |
0.781 (0.378-1.615) |
0.848 (-5.768,7.464) |
|
Chronic heart failure |
17 (1.5) |
9.866 (3.006-32.381) |
-0.673 (-2.832,1.487) |
0.453 (0.145-1.421) |
3.244 (-6.921,13.409) |
|
Stroke |
13 (1.1) |
1.405 (0.282-7.017) |
-0.497 (-2.962,1.969) |
–+ |
-5.201 (-16.803,6.402) |
|
Peptic ulcer |
79 (6.8) |
1.267 (0.709-2.266) |
0.136 (-0.895,1.166) |
1.373 (0.797-2.366) |
2.775 (-2.071,7.621) |
|
Neoplasm |
39 (3.3) |
9.826 (4.702-20.533) |
-0.720 (-2.160,0.719) |
0.919 (0.435-1.940) |
8.261 (1.500,15.022) |
|
Chronic kidney disease |
24 (2.1) |
5.906 (2.452-14.223) |
-0.822 (-2.645,1.001) |
1.575 (0.600-4.134) |
3.624 (-4.956,12.205) |
|
Liver disease |
52 (4.4) |
0.811 (0.355-1.850) |
0.331 (-0.923,1.586) |
1.786 (0.908-3.512) |
5.687 (-0.207,11.582) |
|
Infections |
55 (4.7) |
5.092 (2.823-9.184) |
1.418 (0.199,2.636) |
1.165 (0.630-2.153) |
6.225 (0.488,11.962) |
|
Anticoagulation therapy |
24 (2.1) |
3.557 (1.453-8.707) |
-0.567 (-2.390,1.257) |
0.336 (0.111-1.017) |
-2.587 (-11.169,5.995) |
OR: odds ratio. CI: confidence interval. +Not analysed due to few registered cases (n=5). Significance level p<0.05.
Disclosure:
M. Andrés,
None;
F. Sivera,
None;
S. Pérez-Vicente,
None;
L. Carmona,
Roche Pharmaceuticals,
2,
Pfizer Inc,
2,
Abbott Immunology Pharmaceuticals,
2;
P. Vela,
None.
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