scholarly journals POS0297 HOSPITAL ADMISSIONS FOR PATIENTS WITH RHEUMATOID ARTHRITIS IN WESTERN AUSTRALIA HOSPITALS HAVE DECLINED OVER TIME

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 373.2-374
Author(s):  
K. Almutairi ◽  
J. Nossent ◽  
D. Preen ◽  
H. Keen ◽  
C. Inderjeeth
Keyword(s):  
Rheumatoid Arthritis ◽  
Western Australia ◽  
Hospital Admissions ◽  
Research Training ◽  
International Classification Of Diseases ◽  
Diagnostic Code ◽  
Annual Average ◽  
Period Prevalence ◽  
Average Percentage ◽  
Average Decrease

Background:Rheumatoid arthritis (RA) represents a substantial burden on patients and society in terms of morbidity, enduring disability, and medical expenses (1). RA prevalence is poorly described in Australia, and linked health datasets can provide a more meaningful picture for RA epidemiology in the Australian population.Objectives:To describe the period prevalence rate of RA patients per 1000 hospital separations coded as RA primary or secondary diagnosis in Western Australia (WA) hospitals between 1995 and 2014.Methods:We extracted data on all patients identified in the WA Hospital Morbidity Data Collection between 1995 and 2014, with the International Classification of Diseases (ICD) codes for RA (ICD 10 M05.00–M06.99, and the corresponding ICD 9 codes). We estimated period prevalence rates per 1000 hospital separations and annual average percentage changes, with the total number of hospital separations each year.Results:A total of 17,125 patients were admitted to WA hospitals with a diagnostic code for RA over the study period (1995-2014). The total number of hospital separations for RA patients was 50,353, indicating an average of three hospital separations per patient over twenty years. The RA prevalence was 3.4 per 1000 separations over the study period, with a -2.89% annual average decrease since 1995.Conclusion:These data demonstrate that hospitalisation for RA has decreased considerably in WA over the last two decades. As this decrease roughly coincides with the introduction of biological drug treatment for RA, the reduced need for hospital admission is likely due to improvements in RA management.References:[1]Uhlig T, Moe RH, Kvien TK (2014) The burden of disease in rheumatoid arthritis. Pharmacoeconomics 32:841-851. doi:10.1007/s40273-014-0174-6Acknowledgements:Khalid Almutairi was supported by an Australian Government Research Training Program PhD Scholarship at the University of Western Australia.Disclosure of Interests:Khalid Almutairi: None declared, Johannes Nossent Speakers bureau: Janssen, David Preen: None declared, Helen Keen Speakers bureau: Pfizer Australia, Abbvie Australia, Charles Inderjeeth Speakers bureau: Eli Lilly

scholarly journals Hospital Admissions for Patients with Rheumatoid Arthritis in Western Australia Hospitals Have Declined Significantly Over Time (1995-2014)

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Khalid Bander Almutairi ◽  
Johannes Nossent ◽  
David Preen ◽  
Helen Keen ◽  
Charles Inderjeeth
Keyword(s):  
Hospital Admissions ◽  
International Classification Of Diseases ◽  
Diagnostic Code ◽  
Annual Average ◽  
Average Percentage ◽  
Average Decrease ◽  
Morbidity Data ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Hospital Morbidity

IntroductionRheumatoid arthritis (RA) imposes a considerable burden on society in terms of morbidity, long-term disability, and costs. RA prevalence is poorly described in Australia, and linked health datasets can provide a more meaningful picture for RA epidemiology in the Australian population. Objectives and ApproachWe extracted data on all patients identified in the WA Hospital Morbidity Data Collection between 1995 and 2014, with the International Classification of Diseases (ICD) codes for RA (ICD 10 M05.00–M06.99, and the corresponding ICD 9 codes). We estimated RA point- and period prevalence rates per 1000 hospital separations and annual average percentage changes, with the total number of hospital separations each year obtained from the Australian Institute of Health and Welfare, which served as the denominator. ResultsA total of 17,125 patients were admitted to WA hospitals with a diagnostic code for RA over the study period (1995-2014). The total number of hospital separations for RA patients was 50,353, indicating an average of three hospital separations per patient over twenty years. The RA prevalence was 3.4 per 1000 separations over the study period, with a -2.89% annual average decrease since 1995.The RA point prevalence remained constant in the early part of the study period, at 7.9 per 1000 separations, then decreased in the later years, from 3 per 1000 separations in 2009 to 1.9 per 1000 separations in 2014. Conclusion / ImplicationsThese data demonstrate that hospitalisation for RA has decreased considerably in WA over the last two decades. As this decrease roughly coincides with the introduction of biological drug treatment for RA, the reduced need for hospital admission is likely due to improvements in RA management.

scholarly journals 750Hospital admissions for patients with rheumatoid arthritis in Western Australia hospitals have declined over time

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Khalid Almutairi ◽  
◽  
◽  
◽  
Keyword(s):  
Rheumatoid Arthritis ◽  
International Classification Of Diseases ◽  
Diagnostic Code ◽  
Annual Average ◽  
Average Percentage ◽  
Average Decrease ◽  
Morbidity Data ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Hospital Morbidity

Abstract Background Rheumatoid arthritis (RA) imposes a considerable burden on society in terms of morbidity, long-term disability, and costs. RA prevalence is poorly described in Australia, and linked health datasets can provide a more meaningful picture for RA epidemiology in the Australian population. Methods We extracted data on all patients identified in the WA Hospital Morbidity Data Collection between 1995 and 2014, with the International Classification of Diseases (ICD) codes for RA (ICD 10 M05.00–M06.99, and the corresponding ICD 9 codes). We estimated period prevalence rates per 1000 hospital separations and annual average percentage changes, with the total number of hospital separations each year. Results A total of 17,125 patients were admitted to WA hospitals with a diagnostic code for RA over the study period (1995-2014). The total number of hospital separations for RA patients was 50,353, indicating an average of three hospital separations per patient over twenty years. The RA prevalence was 3.4 per 1000 separations over the study period, with a -2.89% annual average decrease since 1995. Conclusion These data demonstrate that hospitalisation for RA has decreased considerably in WA over the last two decades. As this decrease roughly coincides with the introduction of biological drug treatment for RA, the reduced need for hospital admission is likely due to improvements in RA management. Key messages The RA prevalence was 3.4 per 1000 separations over the study period (1995-2014).

scholarly journals POS0632 THE LONGITUDINAL ASSOCIATIONS OF METHOTREXATE AND BIOLOGIC USE ON HOSPITAL ADMISSION FOR RHEUMATOID ARTHRITIS PATIENTS IN WESTERN AUSTRALIA POPULATION (1995- 2014)

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 554.1-554
Author(s):  
K. Almutairi ◽  
J. Nossent ◽  
D. Preen ◽  
H. Keen ◽  
C. Inderjeeth
Keyword(s):  
Rheumatoid Arthritis ◽  
Hospital Admission ◽  
Western Australia ◽  
Hospital Admissions ◽  
Burden Of Illness ◽  
Population Census ◽  
Diagnostic Code ◽  
Inverse Association ◽  
Conventional Dmards ◽  
The Impact

Background:Rheumatoid arthritis (RA) carries a substantial burden for patients and society in terms of morbidity, enduring disability, and costs [1]. The Australian Pharmaceutical Benefits Scheme (PBS) has subsidised biological disease-modifying anti-rheumatic drugs (B-DMARDs) since 2003 [2].Objectives:We examined the impact of B-DMARDs availability on RA hospitalisation rate in the Western Australia (WA) population pre- and post- B-DMARDs introduction to the PBS (1995-2002 and 2003-2014).Methods:Population PBS dispensing data for WA of DMARD were obtained and converted to defined daily doses (DDD)/1000 population/day using the WA population census. RA inpatient records were extracted from the WA Hospital Morbidity Data Collection using ICD-9 codes 714 and ICD-10 codes M05.00–M06.99). Principal component analysis (PCA) was applied to determine the relationship between DMARDs use and RA hospital admission rates.Results:There was a total of 17,125 patients who had 50,353 admissions with a diagnostic code for RA during the study period. DMARD use for RA rose from 1.45 to 3.19 DDD/1000 population/day over 1995-2014 (Figure 1). In 1995-2002, the number of RA admissions fell from 7.9 to 2.6 per 1000 hospital separations, then dropped further from 2.9 to 1.9 per 1000 hospital separations in 2003-2014. Based on PCA analysis, conventional DMARDs (methotrexate) and B-DMARDs dispensing had an inverse association with hospital admissions for RA.Conclusion:The increased availability of conventional and biological DMARDs for RA was associated with a significant decline in hospital admissions for RA patients in WA.References:[1]Boonen A, Severens JL (2011) The burden of illness of rheumatoid arthritis. Clin Rheumatol 30:3-8.[2]Medicare Australia (2020) Pharmaceutical Benefits Schedule statistics. http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp.Figure 1.The hospital separations and total drugs use patterns of RA in 1995-2014 in Western Australia.Acknowledgements:Supported by an Australian Government Research Training Program PhD Scholarship at the University of Western Australia.Disclosure of Interests:Khalid Almutairi: None declared, Johannes Nossent Speakers bureau: Janssen, David Preen: None declared, Helen Keen Speakers bureau: Pfizer Australia, Abbvie Australia, Charles Inderjeeth Speakers bureau: bureau: Eli Lilly

scholarly journals A Longitudinal Study of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Patients with Rheumatoid Arthritis: A 13-year Population Health Study

2017 ◽  
Vol 44 (10) ◽  
pp. 1421-1428 ◽  
Author(s):  
John G. Hanly ◽  
Kara Thompson ◽  
Chris Skedgel
Keyword(s):  
Rheumatoid Arthritis ◽  
Emergency Room ◽  
Hospital Admissions ◽  
Family Physicians ◽  
International Classification Of Diseases ◽  
Case Definition ◽  
Health Study ◽  
Case Definitions ◽  
Healthcare Data ◽  
Universal Healthcare

Objective.To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of rheumatoid arthritis (RA) cases and matched control patients over 13 years.Methods.A retrospective cohort study was performed using administrative healthcare data from about 1 million people with access to universal healthcare. Using the International Classification of Diseases, 9th ed (ICD-9) and ICD-10 diagnostic codes, 7 RA case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years.Results.The number of incident RA cases varied from 3497 to 27,694, depending on the case definition. The mean age varied from 54.3 to 65.0 years, and the proportion of women from 67.8% to 71.3%. The number of physician encounters by patients with RA was significantly higher than by controls. It was highest in the index year and declined promptly thereafter for all case definitions and by 12.2%–46.8% after 10 years. Encounters with subspecialty physicians fell by 61% (rheumatologists) and 34% (internal medicine). In contrast, clinical encounters with family physicians and other physicians fell by only 9%. Visits to the ER and hospital admissions were also significantly higher in RA cases, particularly early in the disease, and fell significantly over the followup.Conclusion.In patients with RA, healthcare use is highest in the first year following the diagnosis, which is also the time of maximal involvement by rheumatologists. Use declines over time, and encounters with patients’ family physicians predominate over other physician groups.

scholarly journals AB0103 THE ACCURACY OF ADMINISTRATIVE HEALTH DATA FOR IDENTIFYING PATIENTS WITH RHEUMATOID ARTHRITIS: A VALIDATION STUDY USING MEDICAL RECORDS IN WESTERN AUSTRALIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1079.3-1080
Author(s):  
K. Almutairi ◽  
J. Nossent ◽  
D. Preen ◽  
H. Keen ◽  
K. Roger ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Positive Predictive Value ◽  
Hospital Discharge ◽  
Western Australia ◽  
Predictive Value ◽  
Medical Records ◽  
Health Data ◽  
Classification Criteria ◽  
Diagnostic Code ◽  
Diagnostic Codes

Background:The use of large administrative health datasets is increasingly important in Rheumatology for disease trends and outcome research (1). We established the West Australian Rheumatic Disease Epidemiological Registry containing longitudinal health data for over 10000 patients with Rheumatoid Arthritis (RA) in Western Australia (WA). Accuracy of coding for RA is essential to validity of the datasets.Objectives:Investigate the diagnostic accuracy of International Classification of Diseases (ICD) based discharge codes for RA at WA’s largest tertiary hospital.Methods:Medical records for RA patients randomly selected from the hospital discharge database with ICD 10 codes (M05.00–M06.99) from 2008–2020 were retrospectively reviewed. Rheumatologist reported diagnosis and ACR/EULAR classification were used as gold standards to determine positive predictive value (PPV) with 95% Confidence Interval (CI) for RA primary diagnostic codes.Results:Medical chart review was completed for 87 patients (mean age 64.7 years, 67% female). Total of 80 (92%) patients had specialist confirmed RA diagnoses, while seven patients (8%) had alternate clinical diagnoses providing a PPV of 93.5% (95%CI: 89.9 to 95.86). Overall, 69 out 87 patients (79.3%) fulfilled ACR/EULAR classification criteria based on RA primary diagnostic codes with a PPV of 80.5% (95%CI: 76.81 to 83.7). A combination of a diagnostic RA code with biologic infusion codes in two or more codes increased the PPV to 97.9%.Conclusion:Hospital discharge diagnostic codes in WA identify RA patients with a high degree of accuracy. Combining a primary diagnostic code for RA with biological infusion codes can further increase the PPV.References:[1]Hanly et al. The use of administrative health care databases to identify patients with rheumatoid arthritis. Open Access Rheumatol 2015; 7: 69–75.Table 1.Accuracy measures of different algorithms for random sample of rheumatoid arthritis (RA) patients with one or more RA codes.Rheumatologist-reported diagnosisACR/EULAR classification criteriaAdministrative dataSNSPPPVNPVSNSPPPVNPVOne or more RA primary codes90%28.5%93.5%7.6%89.8%16.6%80.5%30%One or more RA biological infusion codes25%71.4%90.9%7.7%20.3%55.5%63.6%15.3%Two or more RA codes including biological codes60%85.7%97.9%15.8%56.5%44.4%79.6%21%RA=Rheumatoid Arthritis, SN=Sensitivity, SP=Specificity, PPV= Positive predictive value, NPV= Negative predictive value.Acknowledgements:Khalid Almutairi was supported by an Australian Government research training Program PhD Scholarship at the University of Western Australia.Disclosure of Interests:Khalid Almutairi: None declared, Johannes Nossent Speakers bureau: Janssen, David Preen: None declared, Helen Keen Speakers bureau: Pfizer Australia, Abbvie Australia, Katrina Roger: None declared, Charles Inderjeeth Speakers bureau: Eli Lilly

scholarly journals SAT0172 UTILIZATION OF HYDROXYCHLOROQUINE AND CORTICOSTEROIDS AMONG LUPUS PATIENTS WITH INCIDENT END-STAGE RENAL DISEASE (ESRD) ONSET: A LONGITUDINAL STUDY USING USRDS REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1027.2-1027
Author(s):  
A. R. Broder ◽  
W. Mowrey ◽  
A. Valle ◽  
B. Goilav ◽  
K. Yoshida ◽  
...  
Keyword(s):  
United States ◽  
Lupus Nephritis ◽  
Renal Disease ◽  
International Classification Of Diseases ◽  
The United States ◽  
Diagnostic Code ◽  
Prescribing Practices ◽  
Part D ◽  
Stage Renal Disease

Background:The development of ESRD due to lupus nephritis is one of the most common and serious complications of SLE. Mortality among SLE ESRD patients is 4-fold higher compared to lupus nephritis patients with preserved renal function1Mortality in SLE ESRD is also twice as high compared with non-SLE ESRD, even though SLE patients develop ESRD at a significantly younger age. In the absence of ESRD specific guidelines, medication utilization in SLE ESRD is unknown.Objectives:The objective of this study was to investigate the real-world current US-wide patterns of medication prescribing among lupus nephritis patients with new onset ESRD enrolled in the United States Renal Disease Systems (USRDS) registry. We specifically focused on HCQ and corticosteroids (CS) as the most used medications to treat SLE.Methods:Inclusion: USRDS patients 18 years and above with SLE as a primary cause of ESRD (International Classification of Diseases, 9thRevision (ICD9) diagnostic code 710.0, previously validated2). who developed ESRD between January 1st, 2006 and July 31, 2011 (to ensure at least 6 months of follow-up in the USRDS). Patients had to be enrolled in Medicare Part D (to capture pharmacy claims). The last follow-up date was defined as either the last date of continuous part D coverage or the end of the study period, Dec 31, 2013.Results:Of the 2579 patients included, 1708 (66%) were HCQ- at baseline, and 871 (34%) were HCQ+ at baseline. HCQ+ patients at baseline had a slightly lower duration of follow-up compared to HCQ- patients at baseline, median (IQR) of 2.32 (1.33, 3.97) years and 2.55 (1.44, 4.25) years, respectively, p= 0.02. During follow-up period, only 778 (30%) continued HCQ either intermittently or continuously to the last follow-up date, 1306 (51%) were never prescribed HCQ after baseline, and 495 (19%) discontinued HCQ before the last follow-up date. Of the 1801 patients who were either never prescribed or discontinued HCQ early after ESRD onset, 713 (40%) were prescribed CS to the end of the follow-up period: 55% were receiving a low dose <10mg/daily, and 43 were receiving moderate dose (10-20mg daily)Conclusion:HCQ may be underprescribed and CS may be overprescribed in SLE ESRD. Changing the current prescribing practices may improve outcomes in SLE ESRDReferences:[1]Yap DY et al., NDT 2012.[2]Broder A et al., AC&R 2016.Acknowledgments :The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the U.S. government.Funding: :NIH/NIAMS K23 AR068441 (A Broder), NIH/NIAMS R01 AR 057327 and K24 AR 066109 (KH Costenbader)Disclosure of Interests: :Anna R. Broder: None declared, Wenzhu Mowrey: None declared, Anna Valle: None declared, Beatrice Goilav: None declared, Kazuki Yoshida: None declared, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca

scholarly journals POS0287 USE OF BIOLOGIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS IN RELATION TO THE RISK OF LYMPHOMA: A COHORT STUDY OF US VETERANS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 369.1-369
Author(s):  
N. Singh ◽  
A. Peterson ◽  
A. Baraff ◽  
A. Korpak ◽  
M. Vaughan-Sarrazin ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Native American ◽  
Diagnostic Code ◽  
Health Administration ◽  
Inception Cohort ◽  
Regular User ◽  
Psoriatic Arthropathy ◽  
Disease Modifying ◽  
Us Veterans ◽  
Lymphoma Risk

Background:Epidemiologic studies suggest that disease duration and degree of inflammatory activity of rheumatoid arthritis (RA) contribute to lymphoma development. However, the association of the use of biologic disease modifying anti-rheumatic drugs (bDMARDs) in patients with RA on lymphoma risk needs further evaluation.Objectives:Examine the effect of administration of bDMARDS on the incidence of lymphoma in an inception cohort of RA.Methods:We identified patients diagnosed with RA in any US Veterans Affairs (VA) facility from 1/1/2002 and 12/31/2018 using the Veteran’s Health Administration (VHA) databases. To be included, each patient was required to meet the following criteria: 1) 2+ RA diagnostic codes at least 7 days apart but no more than 365 days apart 2) a prescription for a conventional synthetic DMARD (csDMARD) within 90 days of the first RA diagnosis 3) One inpatient or outpatient visit 30 days to 2 years preceding first RA diagnosis (indicating they are a regular user of the VHA). We excluded patients for any of the following if they preceded the first RA diagnosis: 1) a prior single RA diagnostic code 2) a prescription for any DMARD medication 3) a concomitant diagnosis of another inflammatory arthritis (e.g. psoriatic arthropathy) 4) a diagnosis of lymphoma. Index date for the study is the date of the first qualifying RA diagnosis. Lymphoma diagnoses were identified through VHA records using the International Classification of Diseases-Oncology codes.Results:We identified 27,536 veterans with RA in the study period meeting the inclusion and exclusion criteria. Of these, 53% (n=14,705) were in the age range 60 to 80 years. The cohort was 89% male, 75.5% White, 13.7% African American. Over the study period, 1.2% (n=332) of the study population developed a lymphoma.Conclusion:Using the nationwide VHA we have identified a large inception cohort of patients with RA of whom 1.2% developed lymphoma over study follow-up. This data will be used in future analyses to produce estimates of the effect of biologic medications on lymphoma risk, adjusting for confounding by indication and other variables.Table 1.Baseline characteristics of the cohort based on bDMARD exposure statusCharacteristicbDMARD-naive (n= 19,095)bDMARD-exposed (n=8,441)Overall Lymphomas Age (years)171161 18-4046 40-606378 60-8010074 >8043 Males17,206 (90%)7,270 (86%)Race White14,150 (74%)6,627 (76%) Black2,674 (14%)1,090 (13%) Asian96 (0.5%)46 (0.5%) Native American or Pacific Islander371 (2%)187 (2.2%) Missing1,804 (9%)491 (6%)Acknowledgements:The work in this abstract is supported by Investigator Award from the Rheumatology Research Foundation to Dr Singh.Disclosure of Interests:None declared

scholarly journals AB0142 SOCIOECONOMIC STATUS (SES) AND MEDICATION USE IN RHEUMATOID ARTHRITIS (RA): A SCOPING REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1098.2-1099
Author(s):  
O. Russell ◽  
S. Lester ◽  
R. Black ◽  
C. Hill
Keyword(s):  
Rheumatoid Arthritis ◽  
Socioeconomic Status ◽  
Scoping Review ◽  
Research Training ◽  
Medication Use ◽  
Study Group ◽  
Knowledge Gaps ◽  
Coverage Area ◽  
Race Ethnicity ◽  
The Impact

Background:Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain.Objectives:To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain.Methods:MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable.SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables.Results:1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA.Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded.Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded.96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.)Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates.70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies.Conclusion:Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use.References:[1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73.[2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9.[3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2.[4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64.Acknowledgements:This research was supported by an Australian Government Research Training Program Scholarship.Disclosure of Interests:None declared

scholarly journals POS0530 HOW DOES MULTIMORBIDITY IMPACT ON THE DIRECT AND INDIRECT COSTS IN PATIENTS WITH RHEUMATOID ARTHRITIS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 498.3-499
Author(s):  
P. H. Hsieh ◽  
C. Geue ◽  
O. Wu ◽  
E. McIntosh
Keyword(s):  
Rheumatoid Arthritis ◽  
Early Rheumatoid Arthritis ◽  
Employment Status ◽  
Functional Disability ◽  
Hospital Admissions ◽  
Information Service ◽  
Indirect Costs ◽  
Direct Costs ◽  
Direct And Indirect Costs ◽  
The Impact

Background:Comorbidities are prevalent in patients with rheumatoid arthritis (RA) and associated with worse outcomes as well as higher economic burden. Little is known about the impact of multimorbidity on the direct and indirect costs of RA. Evidence of the incremental scale of these multimorbidity costs will usefully inform RA interventions and policies.Objectives:The aim of this study was to describe how multimorbidity impacts on the cost-of-illness, including direct and indirect costs, in patients with RA.Methods:The Scottish Early Rheumatoid Arthritis (SERA) is a registry of patients newly presenting with RA since 2011. It contains data on patient characteristics, clinical outcomes, health-related quality of life, and employment status data. These data were linked to routinely recorded hospital admissions and primary care prescribing data. Direct costs were estimated by applying relevant unit costs to healthcare resource use quantities. Indirect cost estimates were obtained from information on employment status and hospital admissions, valued by age and sex specific wages. Two-part models (probit followed by generalized linear model) were used to estimate direct and indirect costs, adjusting for age, gender, and functional disability. The Charlson Comorbidity Index (CCI) score was calculated using patient ICD-10 diagnoses from hospital records. The number of comorbidities was categorized into “RA alone”, “single comorbidity” and “multimorbidity (>1 comorbidity)”.Results:Data were available for 1,150 patients, 65.7% were female and a mean age of 57.5±14 years. The majority of patients only had RA (54.1%), followed by a single comorbidity (23.4%) and multimorbidity (22.5%). Annual total costs were significantly higher for patients with multimorbidity (£6,669 95% CI £4,871-£8,466; OR 11.3 95% CI 8.14-15.87) and for patients with a single comorbidity (£2,075 95% CI £1,559-£2,591; OR 3.52 95% CI 2.61-4.79), when compared with RA alone (£590). The excess costs were mainly driven by direct costs (£6,281 versus £1,875 versus £556). Although the difference in indirect costs between patients with multimorbidity and a single comorbidity were not statistically significant (£1,218 versus £914, p=0.11), patients with multimorbidity were associated with significantly higher costs than those with RA only (£594, p<0.01).Conclusion:The presence of comorbidity contributes significant excess to both direct and indirect costs among RA patients. In particular, patients with multimorbidity incurred substantially higher direct costs than those with a single comorbidity or RA only.Acknowledgements:The study analysed the data from the Scottish Early Rheumatoid Arthritis (SERA) study with a linkage to routinely recorded health data from Information Service Division, National Service Scotland. We would like to thank all the patients, clinical and nursing colleagues who have contributed their time and support to the study, the SERA steering committee for the approval, and Allen Tervit from the Robertson Centre for Biostatistics, University of Glasgow for the timely technical supports.Disclosure of Interests:Ping-Hsuan Hsieh: None declared, Claudia Geue: None declared, Olivia Wu Consultant of: OW has received consultancy fees from Bayer, Lupin and Takeda outside the submitted work., Emma McIntosh: None declared

Increased prevalence of psychosis in patients who get admitted with atrial fibrillation with worse outcomes

2017 ◽  
Vol 41 (S1) ◽  
pp. S575-S576
Author(s):  
Z. Mansuri ◽  
S. Patel ◽  
P. Patel ◽  
O. Jayeola ◽  
A. Das ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Admissions ◽  
Temporal Trends ◽  
International Classification Of Diseases ◽  
Trend Test ◽  
Classification Of Diseases ◽  
Competing Interest ◽  
Armitage Trend Test ◽  
The Impact

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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