Lee Jeong Seok, Oh Baek-Lok, Lee Hee Young, Song Yeong Wook, Lee Eun Young
Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
PLoS One. 2018 Feb 8;13(2):e0192524. doi: 10.1371/journal.pone.0192524. eCollection 2018.
Ankylosing spondylitis (AS) is an inflammatory rheumatic disease typically diagnosed in young age and follows a chronic progressive course. Its impact on the patient is life-long and the burden that AS exerts on society is increasing cumulatively every year. We aimed to quantify the burden of AS and to identify the factors associated with comorbidity, disability, and healthcare expenditure in Korean AS patients.
We conducted a nationwide, population-based study using health insurance data (2003-2013). The analysis included individuals with incident AS (1,111 patients) and controls (5,555 patients) matched by age, sex, income, and geographic region. The incidence rates of extra-articular manifestations (EAMs), comorbidities, mortality, and disability (type and severity) were compared between AS patients and controls. Annual health expenditure per patient was also analyzed. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (95%CIs).
During the follow-up, 28% of AS patients experienced at least one EAM. AS diagnosis was significantly associated with Charlson comorbidity index ≥3 (OR 2.18, 95% CI 1.91-2.48). Disability rate was higher in AS patients than in controls regardless of cause and severity (OR 2.94, 95% CI 2.48-3.48), but crude incidence rate ratios for mortality were not significantly higher. On multivariate analysis, male sex (OR 3.18, 95% CI 2.13-4.75), presence of an EAM (OR 1.63, 95% CI 1.15-2.32), and older age at diagnosis (OR 1.27, 95% CI 1.20-1.35) were evidently associated with increased disability in AS. Presence of an EAM was also associated with increased AS-unrelated expenditures in biologic-naïve patients (median, 1112 vs. 877 USD per person, P < 0.05).
In patients with AS, demographic factors and systemic manifestations including EAMs and other comorbidities were associated with increased disability and healthcare expenditures.
强直性脊柱炎（AS）是一种炎症性风湿性疾病，通常在年轻时被诊断出来，并且呈慢性进行性病程。它对患者的影响是终身的，并且AS每年给社会带来的负担正在累积增加。我们旨在量化AS的负担，并确定韩国AS患者中与合并症、残疾和医疗保健支出相关的因素。
我们使用健康保险数据（2003 - 2013年）进行了一项全国性的基于人群的研究。分析包括初发AS患者（1111例）和按年龄、性别、收入和地理区域匹配的对照组（5555例）。比较了AS患者和对照组关节外表现（EAM）、合并症、死亡率和残疾（类型和严重程度）的发生率。还分析了每位患者的年度医疗支出。关联以比值比（OR）和95%置信区间（95%CI）表示。
在随访期间，28%的AS患者经历了至少一种EAM。AS诊断与Charlson合并症指数≥3显著相关（OR 2.18，95%CI 1.91 - 2.48）。无论病因和严重程度如何，AS患者的残疾率均高于对照组（OR 2.94，95%CI 2.48 - 3.48），但粗死亡率发生率没有显著更高。多因素分析显示，男性（OR 3.18，95%CI 2.13 - 4.75）、存在EAM（OR 1.63，95%CI 1.15 - 2.32）和诊断时年龄较大（OR 1.27，95%CI 1.20 - 1.35）明显与AS患者残疾增加相关。在未使用生物制剂的患者中，存在EAM也与AS无关的支出增加相关（中位数，每人1112美元对877美元，P < 0.05）。
在AS患者中，人口统计学因素和包括EAM及其他合并症在内的全身表现与残疾增加和医疗保健支出相关。
