Epidemiology, comorbidities, and healthcare utilization of patients with chronic urticaria in Germany

Abstract

Background Comprehensive data on the epidemiology and comorbidities of chronic urticaria (CU) in Germany are either limited, or not contemporary.Objectives To investigate the epidemiology of CU, overall comorbidities and healthcare resource utilized by patients with CU in Germany, using an anonymized statutory health insurance (SHI) database.Methods Anonymized SHI claims research database of the Institute for Applied Health Research, Berlin [InGef] (01 January 2015-30 September 2018) was used to analyse insured individuals with a confirmed diagnosis of CU (ICD-10-GM codes). Twelve-month diagnosed prevalence and incidence, comorbidities (vs. atopic dermatitis and psoriasis), and healthcare utilization by patients with CU were investigated. Results Of 4 693 772 individuals of all ages listed in the database, 3 538 540 were observable during 2017. Overall, 17 524 patients (~0.5%) were diagnosed with CU; chronic spontaneous urticaria (CSU: 71.2%), chronic inducible urticaria (CIndU: 19.7%), CSU+CIndU (9.1%). Females, vs. males, had higher diagnosed prevalence (0.62% vs. 0.37%) and diagnosed incidence (0.18% vs. 0.11%) of CU among all patients. Patients most frequently visited general practitioners (41.3% of total visits). Hypertensive diseases (43.5%), lipoprotein metabolism disorders (32.1%) and affective disorders (26.0%) were the most frequently reported comorbidities of special interest. Rates of most comorbidities of special interests were similar to atopic dermatitis and psoriasis patients, and all higher vs. overall population. More than half (54.1%) of all CU patients were not prescribed any treatment. Second-generation H 1 -antihistamines were the most commonly prescribed medication for adult (17.9%) and paediatric (27.9%) patients. Patients with CIndU (paediatric, 15.5%; adult, 7.8%) were more often hospitalized versus patients with CSU (paediatric, 9.9%; adult, 4.6%).Conclusions In Germany, prevalence of CU along with multiple comorbidities may pose increased burden on the healthcare system. Awareness of adhering to treatment guidelines, and aiming for complete control of urticaria, needs to be driven and may improve outcomes.

The common triggers of urticaria in children admitted to the pediatric emergency room

“…1 In childhood, most urticaria are acute (AU), whereas chronic urticaria (CU) is less frequent than in adults. 2 Although urticaria is usually a benign condition, it is one of the common causes of admission to the pediatric emergency department (PED). 3 The main approach to urticaria is the elimination of the underlying causes; however, the exact trigger usually may remain unknown in AU and CU.…”

Comorbidities of Chronic Urticaria: A glimpse into a complex relationship

“…A retrospective population-based cohort study in Denmark found no association between CU and cardiovascular diseases (115). On the contrary, a prospective study showed that systemic hypertension was associated with urticaria persistence (hazard ratio, 0.71; 95% CI 0.53-0.95; p = 0.02) (110), while hypertensive and lipoprotein metabolic disorders were among the more frequent reported comorbidities (43.5% and 32.1% of CU adult population respectively) in a recently published cross-sectional German study (9), and in a Swedish registry based-study (12% and 17% respectively) (116).…”

“…In patients with persist CU, an increasing prevalence of inflammatory diseases was observed, indicating a possible link between inflammation and endurance of CU (125). Back pain, acute upper respiratory infections, noninflammatory disorders of the vagina, spondylosis, and gastritis were among other rare disorders detected by using the anonymized research database of the Institute for Applied Health Research in Berlin, including insured individuals with a diagnosis of CU (9).…”

Urticaria in Pregnancy and Lactation

“…Chronic urticaria (CU) is a chronic inflammatory disorder, which presents with the sudden and unpredictable appearance of wheals, angioedema, or both for longer than 6 weeks ( 1 ). CU is a female dominant disease with a higher diagnosed incidence (0.18 vs. 0.11%) and prevalence (0.62 vs. 0.37%) of females vs. males ( 2 ). Recently a meta-analysis showed that chronic spontaneous urticaria (CSU) has a point prevalence of 1.3 and 0.8% in women vs. men and chronic inducible urticaria (CIndU) shows a female: male ratio of 2:1 to 3:1 ( 3 ).…”