Abstract
OBJECTIVES: ANCA-associated vasculitis (AAV) is considered a chronic, relapsing condition. To date, no studies have investigated multimorbidity in AAV nationally. Here, we characterise temporal trends in multimorbidity and report excess healthcare expenditure associated with it in a national AAV cohort.
METHODS: AAV patients diagnosed between 1997 and 2017 were matched with five general population controls. Linked morbidity and healthcare expenditure data were retrieved from a national hospitalisation repository and nationally-published cost data. Multimorbidity was defined as the development of ≥2 disorders. Pre-specified morbidities were analysed individually and together over time using modified Poisson regression, discrete interval analysis and Chi-squared test for trend. The relationship with healthcare expenditure was investigated using multivariate linear regression.
RESULTS: 543 AAV patients (58.7 [48.9-68.0] years; 53.6% male) and 2,672 controls (58.7 [48.9-68.0] years; 53.7% male) were matched and followed-up for 5.1 years. AAV patients were more likely to develop individual morbidities at all timepoints, but especially <2 years post-diagnosis. The highest proportional risk was observed for osteoporosis (adjusted incident rate ratio 8.0, 95% CI 4.5-14.2). After one year, 23.0% of AAV patients and 9.3% of controls were multimorbid (p<0.0001). After ten years, 37.0% of AAV patients and 17.3% of controls were multimorbid (p<0.0001). Multimorbidity was associated with disproportionate increases in healthcare expenditure in AAV patients. Healthcare expenditure was highest for AAV patients with ≥3 morbidities (3.89, 95% CI 2.83-5.31; p <0.001 versus no morbidities).
CONCLUSIONS: Our findings emphasise the importance of holistic care in AAV and identify a potentially critical opportunity to consider early screening.
| Original language | English |
|---|---|
| Pages (from-to) | 651-659 |
| Number of pages | 9 |
| Journal | Arthritis & Rheumatology |
| Volume | 73 |
| Issue number | 4 |
| Early online date | 5 Mar 2021 |
| DOIs | |
| Publication status | Published - Apr 2021 |
Bibliographical note
Funding: This work was supported by the Aberdeen Development Trust and the Farr Institute of Health Informatics Research. The Farr Institute was supported by a 10‐funder consortium: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the MRC, the NIHR, the National Institute for Social Care and Health Research, the Scottish Government Health Directorates Chief Scientist Office, and the Wellcome Trust (Scotland MR/K007017/1). Dr. Gallacher’s work is supported by the Mason Medical Research Foundation, Lorna Smith Charitable Trust, and a Research Excellence award from the British Heart Foundation (grant RE/18/5/34216).ACKNOWLEDGMENTS
The authors wish to thank electronic Data Research and Innovation Service Scotland for assisting with study approvals and data access in the National Safe Haven, as well as the University of Aberdeen Health Economics Research Unit for their support with the health care utilization analysis.