A.J. Mohammad, MD, MPH, PhD, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden, and Department of Medicine, University of Cambridge, Cambridge, UK;
A. Turkiewicz, PhD, M. Englund, MD, PhD, Clinical Epidemiology Unit, Lund University, Lund, Sweden.
J Rheumatol. 2021 Aug;48(8):1307-1313. doi: 10.3899/jrheum.201131. Epub 2021 Mar 1.
To estimate the healthcare resource utilization (HRU) in patients with giant cell arteritis (GCA) compared with the general population in southern Sweden.
The study sample comprised 653 patients with GCA along with 10 age-, sex-, and residency area-matched reference subjects per patient. Data on public and private healthcare consultations and hospitalizations were extracted from the Skåne Healthcare Register. We assessed trajectories of primary and specialist healthcare visits, as well as hospital admissions and inpatient days from 3 years before through 5 years after the date of GCA diagnosis for patients and matched references. HRU was analyzed using generalized estimating equations adjusted for sex, age at the index year, calendar year of diagnosis, education, income, marital status, place of birth, and Charlson Comorbidity Index. Inverse probability weighting was used to account for dropout during study.
Patients with GCA had higher rates of healthcare visits than the references from the year before GCA diagnosis and up to 4 years after diagnosis, with the largest relative (rate ratio 1.85, 95% CI 1.68-2.05) and absolute (mean difference 10.2, 95% CI 8.1-12.3 visits per person) differences in the year of diagnosis. Similar trajectories were observed for primary and specialist healthcare visits. For hospital admissions and inpatient days, the differences disappeared 1 year after diagnosis date.
Patients with GCA utilized healthcare services at a significantly higher rate than the reference population. The increased utilization among Swedish patients with GCA was evident 1 year before and prolonged up to 4 years after diagnosis date.
评估与瑞典南部普通人群相比,巨细胞动脉炎(GCA)患者的医疗资源利用(HRU)情况。
研究样本包括 653 例 GCA 患者,每位患者匹配 10 名年龄、性别和居住地区相匹配的参考对象。从斯科讷医疗登记处提取了公共和私人医疗咨询以及住院的数据。我们评估了患者和匹配参考对象在 GCA 诊断前 3 年至诊断后 5 年内的初级和专科医疗就诊、住院和住院天数的轨迹。使用广义估计方程对性别、索引年年龄、诊断年份、教育程度、收入、婚姻状况、出生地和 Charlson 合并症指数进行调整,分析 HRU。使用逆概率加权法考虑研究期间的脱落。
与参考对象相比,GCA 患者在 GCA 诊断前一年及诊断后 4 年内的就诊率更高,诊断年的相对(比率比 1.85,95%置信区间 1.68-2.05)和绝对(人均差异 10.2,95%置信区间 8.1-12.3 次就诊)差异最大。初级和专科医疗就诊也呈现出类似的轨迹。对于住院和住院天数,诊断日期 1 年后差异消失。
GCA 患者的医疗服务利用率明显高于参考人群。瑞典 GCA 患者的这种利用率增加在诊断前 1 年就已经明显,并持续到诊断后 4 年。