Session Type: ACR/ARP Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Nearly 25% of patients with SLE are hospitalized each year often for outcomes that may have been avoided if patients had received sustained, high quality outpatient care. A recent Delphi panel defined SLE-specific adverse outcomes that may result in avoidable acute care use (emergency department [ED] visits or hospitalizations) and included 7 vaccine-preventable illnesses. We used U.S. nationwide data from a vulnerable SLE population to describe the burden of acute care use for these illnesses and to examine demographic and healthcare utilization predictors.
Methods: Using claims data from Medicaid (public insurance for low income individuals) from 29 U.S. states (2000-2010), we identified adults (18-65 years) with prevalent SLE (≥3 ICD-9 codes 710.0 separated by ≥30 days). We required 12 months of enrollment prior to the first code (index date) to identify baseline comorbidities, vaccine uptake, and healthcare utilization. We defined avoidable acute care use for vaccine-preventable illnesses as discharge diagnosis codes from ED visits or hospitalizations for influenza, pneumococcal disease, meningococcal disease, herpes zoster, high-grade cervical dysplasia/cervical cancer, and hepatitis B, after the index date. We estimated the incidence rate (IR) of acute care use for vaccine-preventable illnesses and used Cox regression to assess risk (HR, 95% CI) of first acute care visit for vaccine-preventable illnesses by baseline demographics and healthcare use, adjusting for vaccinations, SLE-related comorbidities and medications.
Results: We identified 46,075 Medicaid beneficiaries with SLE with mean follow-up of 4 (SD 3) years. The mean age was 39 (SD 12) and 93% were female, 40% were black, 38% white, 13% Hispanic, 2% Asian. Vaccine uptake during the 12-month baseline period included: 3,331 (7.2%) receiving the influenza vaccine, 1,020 (2.2%) shingles, 551 (1.2%) pneumococcal, 290 (0.63%) hepatitis B, 91 (0.2%) human papillomavirus, and 17 (0.04%) meningitis. The incidence rate of acute care use for vaccine-preventable illnesses was 6.8 per 1,000 person-years; most were herpes zoster, influenza or pneumococcal disease (Table 1). 93% of events occurred in patients who had not received baseline vaccinations. In adjusted analyses, we observed a higher risk of acute care use for vaccine-preventable illnesses among black patients, in the Midwest and South, and among patients with more baseline ED visits and hospitalizations (Table 2). Greater outpatient visits were associated with a dose-response reduction in acute care use, with >30% reduced risk (HR 0.69, 95% CI 0.56-0.74) comparing >10 visits to none.
Conclusion: Claims for vaccinations in this nationwide, vulnerable population of SLE patients were rare, likely reflecting a combination of underreporting and low uptake. As expected, patients with vaccine claims had minimal acute care use for vaccine-preventable illnesses. Greater outpatient use was associated with significantly reduced risk of ED visits and hospitalizations for vaccine-preventable illnesses suggesting that established, consistent outpatient care with optimal SLE monitoring and management, and access to preventive care, can reduce avoidable acute care use.
To cite this abstract in AMA style:Feldman C, Xu C, Costenbader K. Avoidable Acute Care Use for Vaccine-Preventable Illnesses Among Medicaid Beneficiaries with Lupus: Demographic and Healthcare Utilization Differences [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/avoidable-acute-care-use-for-vaccine-preventable-illnesses-among-medicaid-beneficiaries-with-lupus-demographic-and-healthcare-utilization-differences/. Accessed June 1, 2020.
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