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COMORBIDITIES, COMPLEX MULTIMORBIDITY AND PROMIS HEALTH OUTCOMES AMONGAUTOIMMUNE RHEUMATIC DISEASES : DATA FROM THE COVAD STUDY

Gupta, L. (författare)
Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Department of Rheumatology, Wolverhampton, United Kingdom; Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Department of Clinical Immunology and Rheumatology, Lucknow, India; Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Manchester, United Kingdom; Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham, United Kingdom
Ravichandran, N. (författare)
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India
Venerito, V. (författare)
Department of Emergency and Transplantation, University of Bari, Rheumatology Unit, Bari, Italy
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Dey, M. (författare)
University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, United Kingdom; Queen Elizabeth Hospital, Department of Rheumatology, London, United Kingdom
Sen, P. (författare)
Maulana Azad Medical College, MBBS, New Delhi, India
Saha, S. (författare)
Mymensingh Medical College, MBBS, Mymensingh, Bangladesh
Tan, A. L. (författare)
Leeds Teaching Hospitals Trust, NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom; University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
Shinjo, S. Katsuyuki (författare)
Universidade de Sao Paulo, Division of Rheumatology, Faculdade de Medicina FMUSP, Sao Paulo, Brazil
Agarwal, V. (författare)
Mahatma Gandhi Mission Medical College, MBBS, Navi Mumbai, India
Joshi, M. (författare)
Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, MBBS, Pune, India
Ziade, N. (författare)
Saint-Joseph University, Rheumatology Department, Beirut, Lebanon; Hotel-Dieu de France Hospital, Rheumatology Department, Beirut, Lebanon
Velikova, T. (författare)
University Hospital “Lozenetz, Sofia University St. Kliment Ohridski, Department of Clinical Immunology, Medical Faculty, Sofia, Bulgaria
Jagtap, K. (författare)
Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, MBBS, Mumbai, India
Milchert, M. (författare)
Pomeranian Medical University in Szczecin, Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Szczecin, Poland
Parodis, Ioannis, 1981- (författare)
Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Karolinska Institutet and Karolinska University Hospital, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; Örebro University, Department of Rheumatology, Faculty of Medicine and Health, Örebro, Sweden
Gracia-Ramos, A. E. (författare)
General Hospital, National Medical Center “La Raza”, Instituto Mexicano del Seguro Social, Department of Internal Medicine, Mexico City, Mexico
Cavagna, L. (författare)
Università degli studi di Pavia, Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Pavia, Lombardy, Italy
Kuwana, M. (författare)
Nippon Medical School Graduate School of Medicine, Department of Allergy and Rheumatology, Tokyo, Japan
Knitza, J. (författare)
Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Klinik 3 – Rheumatologie und Immunologie, Erlangen, Deutschland, Germany
Makol, A. (författare)
Mayo Clinic, Division of Rheumatology, Rochester, Minnesota, United States of America
Dzifa, D. (författare)
University of Ghana Medical School, College of Health Sciences, Rheumatology Unit, Department of Medicine and Therapeutics, Accra, Ghana
Gutierrez, C. E. Toro (författare)
Pontificia Universidad Javeriana - Cali, General Director, Reference Center for Osteoporosis, Rheumatology and Dermatology, Cali, Colombia
Caballero, C. Vinicio (författare)
University Hospital North, Department of Medicine, Soledad, Colombia
Distler, O. (författare)
University Hospital of Zürich, Department of Rheumatology, Zürich, Switzerland
Day, J. (författare)
WEHI - Walter and Eliza Hall Institute of Medical Research, Department of Rheumatology, Parkville, Australia; University of Melbourne, Department of Medical Biology, Parkville, Australia; Royal Melbourne Hospital, Department of Rheumatology, Parkville, Australia
Chinoy, H. (författare)
Manchester Academic Health Science Centre The University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom; The University of Manchester, National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Department of Rheumatology, Salford, United Kingdom
Aggarwal, R. (författare)
University of Pittsburgh School of Medicine, Department of Clinical Immunology and Rheumatology, Pittsburgh, United States of America
Nikiphorou, E. (författare)
King’s College London, Centre for Rheumatic Diseases, London, United Kingdom; King’s College Hospital, Rheumatology Department, London, United Kingdom
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 (creator_code:org_t)
HighWire Press, 2023
2023
Engelska.
Ingår i: Annals of the Rheumatic Diseases. - : HighWire Press. - 0003-4967 .- 1468-2060. ; 82:Suppl. 1, s. 555-556
Relaterad länk:
https://doi.org/10.1...
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https://urn.kb.se/re...
https://doi.org/10.1...
http://kipublication...
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  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
Abstract Ämnesord
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  • Background: Comorbidities have a profound impact on the QoL of patients living with autoimmune rheumatic diseases (AIRDs). Unfortunately, global data on the burden of comorbidities and its impact on health outcomes in this vulnerable group is scarce.Objectives: We studied the prevalence, distribution and clustering of comorbidities and multimorbidity among patients with AIRDs and healthy controls (HCs) and its impact on health outcomes, utilizing data from the ongoing 2nd COVAD study.Methods: The COVAD study is a global e-survey that embodies patient voice while empowering collaborators and young researchers. The study group of 157 physicians across 106 countries from February-June 2022 captured details of AIRDs, autoimmune and non-autoimmune comorbidities, and validated patient reported outcomes. Human Development Index (UNDP 2021-22) of country of residence was taken as a surrogate marker for socioeconomic status (SES).Basic multimorbidity (BM), Complex multimorbidity (CM), Autoimmune multimorbidity (AM) are defined as the co-occurrence of ≥2 non-rheumatic comorbidities, ≥3 non-rheumatic chronic conditions affecting ≥3 different organ systems [1] and ≥3 autoimmune diseases (AIDs) in an individual respectively.PROMIS global physical health (PGP), mental health (PGM), fatigue 4a (F4a) and physical function short form (SF10) scores were calculated for the different groups and compared using descriptive statistics, linear regression and cluster analysis (hierarchical followed by K means).Results: Of 17,612 total respondents, 6149 (62.7%) had underlying AIRDs and 3652 (37.3%) were HCs, with female (80.8%) and Caucasian (53.9%) predominance in the former.All types of multimorbidity were more frequent in AIRDs than HCs, including any comorbidity (77.1% versus 25.0%; OR: 2.9; 2.7-3.2), BM (21.0% vs 6.2%; 4.0; 3.4-4.6), and CM (3.1% vs 0.5%; 6.4; 3.9-10.4), and with prevalence increasing with age (p<0.001) (Figure 1A, B). Comorbidity prevalence was the highest among Americans and Australians (72% each).Patients with AIRDs had poorer health outcomes than HCs, including lower PGP, PGM, SF10, F4a scores (all p<0.001). Among AIRDs, those with comorbidities had lower physical function and PROMIS scores (PGP, PGM, and SF10), and reported fatigue more often (all p<0.001).Female gender, and underlying BM and AM particularly predisposed patients to worse physical health (lower PGP, lower SF10a) and mental health outcomes (lower PGM). While advanced age (-1.815; <0.001), and lower SES (0.871; 0.027) specifically predicted poorer physical function (lower SF10a). Fatigue (higher F4a) was seen more frequently among women (1.711; <0.001), and those with BM (1.142; 0.002); AM (1.768; 0.011), and higher SEC (0.478; 0.016).Cluster analysis of patients with AIRDs revealed 2 clusters (Figure 1C 1D); cluster 1 with low PGP, PGM, SF10 and high F4a; cluster 2 with high PGP, PGM, SF10 and low F4a. The clusters differed predominantly based on the frequency of comorbidities; any comorbidity (59.7% vs 41.8%; p<0.001), BM (28.5% vs 14.7%; 0.001); CM (4.5% vs 1.9%; <0.001), and AM (10.0% vs 4.0%; <0.001).Conclusion: Comorbidities complicate three-quarters of individuals living with AIRDs, and have an outsized impact on self-reported physical function, perceived fatigue, and QoL. Substantial regional differences call for further exploration of key drivers of this important aspect to allow optimized multidisciplinary and holistic care in anticipation of poorer outcomes.Reference: [1]Harrison C, Britt H, Miller G, Henderson J. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open. 2014 Jul 1;4(7):e004694.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)

Nyckelord

Comorbidities
Patient reported outcomes
COVID

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