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Trends in Hospitalizations for Serious Infections in Patients With Rheumatoid Arthritis in the US Between 1993 and 2013
Author(s) -
Jinno Sadao,
Lu Na,
Jafarzadeh S. Reza,
Dubreuil Maureen
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23328
Subject(s) - medicine , sepsis , rheumatoid arthritis , pneumonia , epidemiology , diagnosis code , urinary system , pediatrics , population , environmental health
Objective The epidemiology of hospitalizations with infections among patients with rheumatoid arthritis ( RA ) is unknown, despite an increase in RA treatments that confer a risk of infection. Methods We examined National Inpatient Sample data from 1993–2013. We identified hospitalizations among adults with RA , defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes (714.xx) in any secondary diagnosis field. We evaluated 5 infections as the primary diagnosis: pneumonia, sepsis, urinary tract infection ( UTI ), skin and soft tissue infections ( SSTI s), and opportunistic infections ( OI s). The primary outcome was the proportion of hospitalizations for each infection among all hospitalizations with a secondary diagnosis of RA . Results There were 792,921 hospitalizations for infection with a secondary diagnosis of RA , with the rates increasing from 90 to 206 per 100,000 persons from 1993–2013. The proportion of hospitalizations decreased for pneumonia (from 5.4% to 4.6%), UTI (from 0.4% to 0.38%), and OI s (from 0.44% to 0.26%). The proportion of hospitalizations for SSTI s increased slightly (from 2.3% to 2.5%), while hospitalizations for sepsis more than tripled (from 1.9% to 6.4%). Conclusion Between 1993 and 2013, the proportion of hospitalizations for infections among RA patients appeared to decline for pneumonia and OI s, with a slight decrease in UTI , a slight increase in SSTI s, and a substantial increase in hospitalizations with sepsis. Our results are consistent with previous reports that the sensitivity of sepsis coding has increased over time.