Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data

Abstract

Objectives The objective of this study was to assess the current diagnostic delay in axial SpA (axSpA) and to analyse factors associated with it. Methods A stratified sample of subjects with a diagnosis of axSpA (International Classification of Diseases, 10th Revision code M45) was drawn from health insurance data in Germany and was questioned on disease-related, lifestyle and socio-economic characteristics. The diagnostic delay was calculated as the time from back pain onset until a diagnosis of axSpA. A multivariable linear regression analysis was performed to explore factors associated with the diagnostic delay. Results Among 1677 patients with axSpA included in the analysis, the mean diagnostic delay was 5.7 years (median 2.3). Of those, 407 patients were diagnosed in 1996–2005 and 484 patients in 2006–2015. The mean diagnostic delay was not substantially different in both periods: 6.3 years (median 2.6) and 7.4 (2.7), respectively. Multivariable linear regression revealed that female sex [β = 1.85 (95% CI 1.06, 2.65)], negative HLA-B27 status [β = 3.61 (95% CI 2.07, 5.14)], presence of psoriasis [β = 1.40 (95% CI 0.08, 2.73)] and younger age at symptom onset [β = 1.91 (95% CI 1.53, 2.29)] were factors associated with a longer diagnostic delay. Conclusion The diagnostic delay in axSpA is still unacceptably long. Patients who are female, young at symptom onset, HLA-B27 negative or have psoriasis have a longer diagnostic delay. Specific referral strategies might be necessary in order to decrease the diagnostic delay in patients presenting with these characteristics.

Contribution of polymorphism in the non-coding region of PPARα to the development of axial spondyloarthritis

“…This result was consistent with the data obtained in a prevalence study conducted by Esther [14]. The mean delay of 2.82 ± 1.41 years in disease diagnosis observed in our study was showed similarity with the data reported in various studies [13,15]. 11.86% of the patients (Table 1) had sustained serious infectious diseases before disease symptoms had manifested [p = 0.002; OR 95% CI: 4.434 (1.740-11.300)].…”

Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review

“…However, there is often a substantial delay between symptom onset and axSpA diagnosis, with recent reports suggesting an average diagnostic delay of 5-14 years [6][7][8][9][10][11]. One factor contributing to the delay in diagnosis of axSpA is the difficulty in distinguishing inflammatory back pain (IBP), a key symptom of axSpA that affects the spine and sacroiliac joints [12,13], from other highly prevalent forms of low back pain in the general population-the overall global prevalence of low back pain is approximately 9% [14], and up to 80% of adults will experience low back pain in their lifetime [15,16].…”

Reality of care for musculoskeletal diseases at the population level

“…Provision of health services [4] Comorbidity [14] Physical therapy [9] Income and burden of disease [6] Depressive symptoms and burden of disease [19] Diagnostic delay [18] Provision of health services Extra-articular manifestations Comorbidity The claims data were analysed not only for the PROCLAIR respondents (linking claims and survey data), but also for all insured persons who had one of the three diagnostic codes. Therefore, some analyses refer to the total data set of BARMER insurants (e.g.…”