Impact of Psychiatric Comorbidity on Health Care Use in Rheumatoid Arthritis: A Population-Based Study.
Adult
Aged
Arthritis, Rheumatoid
/ diagnosis
Comorbidity
Databases, Factual
Female
Health Resources
/ trends
Hospitalization
/ trends
Humans
Male
Manitoba
/ epidemiology
Mental Disorders
/ diagnosis
Mental Health
Middle Aged
Office Visits
/ trends
Polypharmacy
Prescription Drugs
/ therapeutic use
Prevalence
Retrospective Studies
Time Factors
Journal
Arthritis care & research
ISSN: 2151-4658
Titre abrégé: Arthritis Care Res (Hoboken)
Pays: United States
ID NLM: 101518086
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
09
03
2020
revised:
15
06
2020
accepted:
14
07
2020
pubmed:
24
7
2020
medline:
2
2
2021
entrez:
24
7
2020
Statut:
ppublish
Résumé
Psychiatric comorbidity is frequent in rheumatoid arthritis (RA) and complicates treatment. The present study was undertaken to describe the impact of psychiatric comorbidity on health care use (utilization) in RA. We accessed administrative health data (1984-2016) and identified a prevalent cohort with diagnosed RA. Cases of RA (n = 12,984) were matched for age, sex, and region of residence with 5 controls (CNT) per case (n = 64,510). Within each cohort, we identified psychiatric morbidities (depression, anxiety, bipolar disorder, and schizophrenia [PSYC]), with active PSYC defined as ≥2 visits per year. For the years 2006-2016, annual rates of ambulatory care visits (mean ± SD per person) categorized by provider (family physician [FP], rheumatologist, psychiatrist, other specialist), hospitalization (% of cohort), days of hospitalization (mean ± SD), and dispensed drug types (mean ± SD per person) were compared among 4 groups (CNT, CNT plus PSYC, RA, and RA plus PSYC) using generalized linear models adjusted for age, sex, rural versus urban residence, income quintile, and total comorbidities. Estimated rates are reported with 95% confidence intervals (95% CIs). We tested within-person and RA-PSYC interaction effects. Subjects with RA were mainly female (72%) and urban residents (59%), with a mean ± SD age of 54 ± 16 years. Compared to RA without PSYC, RA with PSYC had more than additive (synergistic) visits (standardized mean difference [SMD] 10.92 [95% CI 10.25, 11.58]), hospitalizations (SMD 13% [95% CI 0.11, 0.14]), and hospital days (SMD 3.63 [95% CI 3.06, 4.19]) and were dispensed 6.85 more medication types (95% CI 6.43, 7.27). Cases of RA plus PSYC had increased visits to FPs (an additional SMD 8.92 [95% CI 8.35, 9.46] visits). PSYC increased utilization in within-person models. Managing psychiatric comorbidity effectively may reduce utilization in RA.
Identifiants
pubmed: 32702203
doi: 10.1002/acr.24386
pmc: PMC7839671
doi:
Substances chimiques
Prescription Drugs
0
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
90-99Subventions
Organisme : CIHR
ID : THC-135234
Pays : Canada
Informations de copyright
© 2020 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.
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