Contreras Dani G, Barber Claire E H, Aviña-Zubieta J Antonio, Quan Hude, Lee Seungwon, King James A, Barnabe Cheryl
University of Calgary, Calgary, Alberta, Canada.
Arthritis Research Canada, Vancouver, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2025 Aug;77(8):1014-1021. doi: 10.1002/acr.25541. Epub 2025 May 2.
We estimated incidence rates of avoidable hospitalizations by persons with rheumatoid arthritis (RA) relative to the general population.
We identified individuals meeting a validated case definition for RA based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CA codes in years 2002 to 2023. Four general population controls were matched to each RA case by age and sex. We identified hospitalizations for ambulatory care sensitive conditions (ACSCs), including grand mal seizures, chronic lower respiratory diseases, asthma, diabetes, heart failure and pulmonary edema, hypertension, and angina, from 2007 to 2023 by established diagnostic codes. Incidence rate ratios (IRRs) three and five years from the date of diagnosis were calculated using a multivariable regression model adjusting for age, sex, and location of residence. A Cox proportional hazards model was used to identify predictors of avoidable hospitalizations among patients with RA.
Persons with RA (n = 83,811) had 1.12 times the risk of hospitalization for heart failure and pulmonary edema compared to those without RA (n = 190,304) (IRR 1.12, 95% confidence interval [CI] 1.01-1.25). Significant predictors of ACSC hospitalizations for RA cases were increasing age, prolonged exposure to glucocorticoids, and having comorbid conditions, especially if the comorbid condition was an ACSC (hazard ratio 10.1, 95% CI 7.8-13.0).
Persons with RA are at a higher risk of potentially avoidable hospitalizations three and five years after diagnosis compared to those without RA. Improved ambulatory care access and quality, inclusive of primary care and subspecialty care, is proposed to prevent unnecessary hospitalizations and reduce burden on the acute care system.
我们估计了类风湿关节炎（RA）患者相对于普通人群的可避免住院发生率。
我们根据2002年至2023年的《国际疾病分类，第九次修订本，临床修订版》（ICD - 9 - CM）和ICD - 10 - CA编码，确定符合RA有效病例定义的个体。按照年龄和性别为每例RA患者匹配4名普通人群对照。我们通过既定的诊断编码确定了2007年至2023年因门诊护理敏感疾病（ACSC）导致的住院情况，包括癫痫大发作、慢性下呼吸道疾病、哮喘、糖尿病、心力衰竭和肺水肿、高血压以及心绞痛。使用多变量回归模型计算诊断日期后3年和5年的发病率比（IRR），该模型对年龄、性别和居住地点进行了调整。采用Cox比例风险模型确定RA患者中可避免住院的预测因素。
与无RA的患者（n = 190,304）相比，RA患者（n = 83,811）因心力衰竭和肺水肿住院的风险高1.12倍（IRR 1.12，95%置信区间[CI] 1.01 - 1.25）。RA病例ACSC住院的显著预测因素包括年龄增长、长期使用糖皮质激素以及患有合并症，尤其是合并症为ACSC时（风险比10.1，95% CI 7.8 - 13.0）。
与无RA的患者相比，RA患者在诊断后3年和5年发生潜在可避免住院的风险更高。建议改善门诊护理的可及性和质量，包括初级护理和专科护理，以预防不必要的住院并减轻急性护理系统的负担。
