Avello Alejandro, Fernández-Prado Raúl, Abasheva Daria, Mahillo Ignacio, González-Gay Miguel Ángel, Martín-Cleary Catalina, Arce-Obieta José Miguel, Pérez-Gómez María Vanessa, Fernández-Fernández Beatriz, Ortiz Alberto
Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain.
RICORS2040, Madrid, Spain.
Clin Kidney J. 2025 Jul 1;18(7):sfaf162. doi: 10.1093/ckj/sfaf162. eCollection 2025 Jul.
Differences between regional healthcare systems in the in-hospital burden and care of systemic lupus erythematosus (SLE) and lupus nephritis (LN) are poorly characterized. Their analysis may provide benchmarking opportunities that improve the quality and sustainability of care.
We retrospectively investigated the hospitalization burden of SLE and LN in 2019-2021 across Spanish regional healthcare systems using the Spanish National Hospital Discharge Records database (RAE-CMBD) and National Statistics Institute (INE) data.
Of 66 262 724 hospitalization episodes from 644 public and private hospitals, 10 781 had a primary diagnosis of SLE, of which 2481 (23%) were for LN. The mean annual nationwide hospitalization case incidence was 70.61 and 1.75 per 100 000 population for SLE and LN, respectively. Regional differences were large: 48.0-fold and 6.9-fold between regions with the highest and lowest incidence for SLE and LN, respectively. In multivariate analysis, net household income and percentage of foreign-born population were associated with the number of SLE and LN hospitalization episodes. Internal medicine managed 28% of SLE and 15% of LN hospitalizations, nephrology 14% and 56% and rheumatology 23% and 11%, respectively, but there were large regional differences. The mean SLE and LN stays were 8.85 and 6.92 days (5.47 and 5.41 for nephrology and 11.18 and 11.83 for internal medicine), respectively. The average all patient refined diagnosis related groups (APR-DRGs) cost per episode was €2408 for SLE and €3563 for LN. The average yearly costs were €167 985 per million population (pmp) for SLE hospitalizations (4.32-fold differences between regions) and €60 825 pmp for LN hospitalizations (4.20-fold differences between regions). Large differences between regions were observed in the cost burden pmp relative to household income (4.70-fold for LN and 4.13-fold for SLE).
In real-world clinical practice, the burden of in-hospital care of LN and SLE is heterogeneous across and within regional healthcare systems, offering the opportunity to benchmark best practice, optimize care and improve outcomes.
系统性红斑狼疮（SLE）和狼疮性肾炎（LN）在不同地区医疗系统中的院内负担及护理差异鲜有描述。对这些差异进行分析可能会提供改善护理质量和可持续性的基准制定机会。
我们利用西班牙国家医院出院记录数据库（RAE-CMBD）和国家统计局（INE）的数据，回顾性调查了2019年至2021年西班牙各地区医疗系统中SLE和LN的住院负担。
在644家公立和私立医院的66262724次住院病例中，10781例主要诊断为SLE，其中2481例（23%）为LN。全国范围内SLE和LN的年平均住院病例发病率分别为每10万人70.61例和1.75例。地区差异很大：SLE发病率最高和最低的地区之间相差48.0倍，LN相差6.9倍。在多变量分析中，家庭净收入和外国出生人口百分比与SLE和LN的住院病例数相关。内科管理了28%的SLE住院病例和15%的LN住院病例，肾脏病科分别为14%和56%，风湿病科分别为23%和11%，但地区差异很大。SLE和LN的平均住院天数分别为8.85天和6.92天（肾脏病科分别为5.47天和5.41天，内科分别为11.18天和11.83天）。SLE每次住院的平均所有患者精细诊断相关组（APR-DRGs）费用为2408欧元，LN为3563欧元。SLE住院的年平均费用为每百万人口167985欧元（各地区之间相差4.32倍），LN住院为每百万人口60825欧元（各地区之间相差4.20倍）。各地区之间在相对于家庭收入的每百万人口成本负担方面存在很大差异（LN为4.70倍，SLE为4.13倍）。
在实际临床实践中，LN和SLE的院内护理负担在地区医疗系统内部和之间存在异质性，这为制定最佳实践基准、优化护理和改善结局提供了机会。
