Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

McQueenie, Ross; Nicholl, Barbara I; Jani, Bhautesh; Canning, Jordan; Macdonald, Sara; McCowan, Colin; Neary, Joanne; Browne, Susan; Mair, Frances S; Siebert, Stefan

doi:10.1136/bmjopen-2020-038829

Cited by 20 publications

(23 citation statements)

References 35 publications

(33 reference statements)

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“…The multimorbidity state has been well documented in inflammatory arthritides, such as rheumatoid arthritis [ 21 , 83 , 84 , 85 ], whereas fewer reports exist in SLE [ 86 , 87 ]. A remarkable finding in our study was the high prevalence of multimorbidity with more than half of SLE patients reporting ≥3 physical and about one-third of patients reporting ≥2 mental comorbid diseases.…”

Section: Discussionmentioning

confidence: 99%

High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete

Gergianaki

Garantziotis

Adamichou

et al. 2021

JCM

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Comorbidities and multimorbidity, often complicating the disease course of patients with chronic inflammatory rheumatic diseases, may be influenced by disease-intrinsic and extrinsic determinants including regional and social factors. We analyzed the frequency and co-segregation of self-reported comorbid diseases in a community-based Mediterranean registry of patients (n = 399) with systemic lupus erythematosus (SLE). Predictors for multimorbidity were identified by multivariable logistic regression, strongly-associated pairs of comorbidities by the Cramer’s V-statistic, and comorbidities clusters by hierarchical agglomerative clustering. Among the most prevalent comorbidities were thyroid (45.6%) and metabolic disorders (hypertension: 24.6%, dyslipidemia: 33.3%, obesity: 35.3%), followed by osteoporosis (22.3%), cardiovascular (20.8%), and allergic (20.6%) disorders. Mental comorbidities were also common, particularly depression (26.7%) and generalized anxiety disorder (10.7%). Notably, 51.0% of patients had ≥3 physical and 33.1% had ≥2 mental comorbidities, with a large fraction (n = 86) displaying multimorbidity from both domains. Sociodemographic (education level, marital status) and clinical (disease severity, neurological involvement) were independently associated with physical or mental comorbidity. Patients were grouped into five distinct clusters of variably prevalent comorbid diseases from different organs and domains, which correlated with SLE severity patterns. Conclusively, our results suggest a high multimorbidity burden in patients with SLE at the community, advocating for integrated care to optimize outcomes.

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Section: Discussionmentioning

confidence: 99%

High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete

Gergianaki

Garantziotis

Adamichou

et al. 2021

JCM

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“…It is unclear if COVID-19-related hyperinflammatory response, commonly leading to organ failure (7), is more common among patients with IMIDs who already have dysfunctional host immune systems. Multimorbidity, in particular respiratory, cardiovascular and renal diseases, has been associated with poor COVID-19 outcomes, and is prevalent among many patients with IMIDs (8)(9)(10)(11). Finally, despite attempts to use immune modulating agents to treat severe COVID-19, some of these medications commonly used to manage IMIDs, including corticosteroids, and conventional and biologic immune modulating agents, have been associated with a higher risk of infections (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Hospitalizations, Intensive Care Unit Stays, Ventilation, and Death Among Patients With Immune-mediated Inflammatory Diseases Compared to Controls

Eder¹,

Croxford

Drucker³

et al. 2022

J Rheumatol

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Objective To investigate COVID-19 hospitalization risk in patients with immune mediated inflammatory diseases (IMIDs) compared with matched non-IMID comparators from the general population. Methods We conducted a population-based, matched cohort study using health administrative data from January to July 2020 in Ontario, Canada. Cohorts for each of the following IMIDs were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PsA), ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica and vasculitis. Each patient was matched with 5 non-IMID comparators based on socio-demographic factors. We compared the cumulative incidence of hospitalizations for COVID-19 and their outcomes between IMID and non-IMID patients. Results A total of 493,499 IMID patients (417 hospitalizations) and 2,466,946 non-IMID comparators (1,519 hospitalizations) were assessed. The odds of being hospitalized for COVID- 19 was significantly higher in patients with IMIDs compared with their matched non-IMID comparators (matched unadjusted Odds Ratio (OR) 1.37, adjusted OR 1.23). Significantly higher risk of hospitalizations was found in patients with iritis (OR 1.46), MS (OR 1.83), PsA (OR 2.20), RA (OR 1.42), SARDs (OR 1.47) and vasculitis (OR 2.07). COVID-19 hospitalizations were associated with older age, male sex, long-term care residence, multimorbidity, and lower income. The odds of complicated hospitalizations was 21% higher among all IMID versus matched non-IMID patients, but this association was attenuated after adjusting for demographic factors and comorbidities. Conclusion Patients with IMIDs were at higher risk of being hospitalized with COVID-19. This risk was explained in part by their comorbidities.

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“…heart failure, hypertension, coronary heart disease, peripheral vascular disease, atrial fibrillation, diabetes and stroke), complex LTCs [14] (three or more conditions from three or more body systems) and mixed physical and mental conditions [15]. Two different types of cohort were studied: first, a prospective cohort study was used because it has extensive clinical phenotyping and there is extensive published data demonstrating its utility for studying multimorbidity [16][17][18][19][20]. Second, because healthy volunteer bias can occur in research studies, a nationally representative primary care cohort generated from routine care records was used.…”

Section: Introductionmentioning

confidence: 99%

Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings

Sullivan

Jani

McConnachie

et al. 2021

BMC Med

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Background Chronic kidney disease (CKD) typically co-exists with multimorbidity (presence of 2 or more long-term conditions: LTCs). The associations between CKD, multimorbidity and hospitalisation rates are not known. The aim of this study was to examine hospitalisation rates in people with multimorbidity with and without CKD. Amongst people with CKD, the aim was to identify risk factors for hospitalisation. Methods Two cohorts were studied in parallel: UK Biobank (a prospective research study: 2006-2020) and Secure Anonymised Information Linkage Databank (SAIL: a routine care database, Wales, UK: 2011-2018). Adults were included if their kidney function was measured at baseline. Nine categories of participants were used: zero LTCs; one, two, three and four or more LTCs excluding CKD; and one, two, three and four or more LTCs including CKD. Emergency hospitalisation events were obtained from linked hospital records. Results Amongst 469,339 UK Biobank participants, those without CKD had a median of 1 LTC and those with CKD had a median of 3 LTCs. Amongst 1,620,490 SAIL participants, those without CKD had a median of 1 LTC and those with CKD had a median of 5 LTCs. Compared to those with zero LTCs, participants with four or more LTCs (excluding CKD) had high event rates (rate ratios UK Biobank 4.95 (95% confidence interval 4.82–5.08)/SAIL 3.77 (3.71–3.82)) with higher rates if CKD was one of the LTCs (rate ratios UK Biobank 7.83 (7.42–8.25)/SAIL 9.92 (9.75–10.09)). Amongst people with CKD, risk factors for hospitalisation were advanced CKD, age over 60, multiple cardiometabolic LTCs, combined physical and mental LTCs and complex patterns of multimorbidity (LTCs in three or more body systems). Conclusions People with multimorbidity have high rates of hospitalisation. Importantly, the rates are two to three times higher when CKD is one of the multimorbid conditions. Further research is needed into the mechanism underpinning this to inform strategies to prevent hospitalisation in this very high-risk group.

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Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

Cited by 20 publications

References 35 publications

High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete

High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete

COVID-19 Hospitalizations, Intensive Care Unit Stays, Ventilation, and Death Among Patients With Immune-mediated Inflammatory Diseases Compared to Controls

Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings

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