Multimorbidity in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, multi-centre data-linkage study

Sarica, S. H. et al. (2021) Multimorbidity in anti-neutrophil cytoplasmic antibody-associated vasculitis: results from a longitudinal, multi-centre data-linkage study. Arthritis and Rheumatology, 73(4), pp. 651-659. (doi: 10.1002/art.41557) (PMID:33058567)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Basu, Professor Neil
Authors: Sarica, S. H., Gallacher, P. J., Dhaun, N., Sznajd, J., Harvie, J., McLaren, J., McGeoch, L., Kumar, V., Amft, N., Erwig, L., Marks, A., Bruno, L., Zöllner, Y., Black, C., and Basu, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:Arthritis and Rheumatology
Publisher:Wiley
ISSN:2326-5191
ISSN (Online):2326-5205
Published Online:15 October 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Arthritis and Rheumatology 73(4):651-659
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190658The Scottish eHealth Informatics Research Centre (E-HIRCs).Jill PellMedical Research Council (MRC)MR/K007017/1HW - Public Health