Background/Purpose: Active juvenile idiopathic arthritis (JIA) is commonly associated with high healthcare costs in children. The disabling consequences and multimorbidities often manifest, however, in adulthood. Combining a large clinical dataset on patients at a rheumatology clinic with administrative data on healthcare utilization and costs allows investigating the disease burden to the society. Our aim was to explore the multimorbidities and detailed clinical characteristics in adult JIA patients and to investigate which factors affect their healthcare utilization.

Methods: The patients attending Jyväskylä Central Hospital rheumatology unit, Finland, are enrolled prospectively in a structured digital database, from which we identified all JIA patients. Data is collected systematically on factors such as date of diagnosis, laboratory tests, questionnaire scores, joint counts, functional capacity, and medications on most rheumatology unit visits. We combined this population-based clinical data with well-recorded administrative data on all public healthcare visits, both in primary and specialty care, on fiscal year 2014 to depict healthcare utilization. The data includes visits to physicians and allied health care professionals in outpatient care as well as inpatient care. Diagnoses are recorded as either ICPC-2 or ICD-10, and also converted to a broader disease classification. Associations between clinical characteristics and healthcare costs were investigated with logistic regression.

Results: Of 182 JIA patients (74% women, mean age 34.9 ± 13.6 (SD)), we have data on healthcare utilization from 2014 on 102 (56%) patients with 80% coding coverage. Median number of healthcare contacts (1 contact = 1 disease discussed during an appointment or inpatient episode) was 12 (min = 1, max = 212). When drawing the difference between low and high healthcare utilizors at the upper quartile (75^thpercentile), the only factor associated with high healthcare utilization was ever having received biologics (OR 9.47, 95% CI 2.43-49.35, p < 0.01) compared to never received. Total healthcare costs in euros (€) did not differ between those less than 30 years of age and over 30 (p = 0.12). Of the healthcare contacts with recorded diagnostic codes (rheumatic diagnoses excluded), mental health disorders accounted for 1 in 4 and cardiovascular diseases for 1 in 10. The main mental multimorbidity was depression (52% of all contacts for mental disorders). The main cardiovascular multimorbidity was cardiac arrythmias (57% of all contacts for cardiovascular diseases).

Conclusion: Mental health disorders are common in adult JIA patients. Healthcare professionals should pay attention to mental wellbeing, particularly in young adults with JIA. Further analyses on utilization data from 2012 to 2014 are currently underway for investigating other factors associated with increased healthcare utilization in a larger dataset.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/healthcare-utilization-and-multimorbidities-among-adult-patients-with-juvenile-idiopathic-arthritis/