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High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth
Author(s) -
Chang Joyce C.,
Mandell David S.,
Knight Andrea M.
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.23485
Subject(s) - medicine , interquartile range , incidence (geometry) , ambulatory , diagnosis code , medical diagnosis , emergency department , systemic lupus erythematosus , pediatrics , rate ratio , ambulatory care , lupus erythematosus , health care , emergency medicine , immunology , disease , confidence interval , population , physics , environmental health , pathology , psychiatry , optics , economics , economic growth , antibody
Objective Childhood‐onset systemic lupus erythematosus ( SLE ) is associated with high risk for organ damage, which may be mitigated by early diagnosis and treatment. We characterized health care utilization for youth in the year preceding SLE diagnosis compared to controls. Methods Using Clinformatics DataMart (OptumInsight) de‐identified administrative data from 2000 to 2013, we identified 682 youth ages 10–24 years with new‐onset SLE (≥3 International Classification of Diseases, Ninth Revision codes for SLE 710.0, each >30 days apart), and 1,364 age‐ and sex‐matched healthy controls. We compared the incidence of ambulatory, emergency, and inpatient visits 12 months before SLE diagnosis and frequency of primary diagnoses. We examined subject characteristics associated with utilization preceding SLE diagnosis. Results Youth with SLE had significantly more visits in the year preceding diagnosis than controls across ambulatory (incidence rate ratio [ IRR ] 2.48, P < 0.001), emergency ( IRR 3.42, P < 0.001), and inpatient settings ( IRR 3.02, P < 0.001). The most frequent acute‐care diagnoses and median days to SLE diagnosis were: venous thromboembolism (313, interquartile range [ IQR ] 18–356), thrombocytopenia (278, IQR 39–354), chest pain (73, IQR 29.5–168), fever (52, IQR 17–166), and acute kidney failure (14, IQR 5–168). Having a psychiatric diagnosis prior to SLE diagnosis was strongly associated with increased utilization across all settings. Conclusion Youth with SLE have high health care utilization throughout the year preceding SLE diagnosis. Examining variable diagnostic trajectories of youth requiring acute care preceding SLE diagnosis, and increased attention to psychiatric morbidity, may help improve care for youth with new‐onset SLE .