Multimorbidity in Anti-Neutrophil Cytoplasmic Antibody-associated vasculitis: results from a longitudinal, multi-centre data-linkage study

Shifa H. Sarica, Peter J. Gallacher, Neeraj Dhaun, Jan Sznajd, John Harvie, John McLaren, Lucy McGeoch, Vinod Kumar, Nicole Amft, Lars Erwig, Angharad Marks, Laura Bruno, York Zöllner, Corri Black, Neil Basu (Lead / Corresponding author)

    Research output: Contribution to journalArticlepeer-review

    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.

    Original languageEnglish
    Number of pages25
    JournalArthritis and Rheumatology
    DOIs
    Publication statusE-pub ahead of print - 15 Oct 2020

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