High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth

Chang, Joyce; Mandell, David S.; Knight, Andrea

doi:10.1002/acr.23485

Cited by 18 publications

(19 citation statements)

References 38 publications

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“…11,12 Incident SLE cases had at least 12 months of claims data with no SLE codes in any position preceding the first primary or secondary SLE diagnosis code, as previously described. 13 The date of the first SLE code was considered the date of SLE diagnosis. In order to capture cardiac diagnoses occurring immediately before SLE diagnosis, the index date for yearly incidence calculations was defined as 30 days prior to SLE diagnosis.…”

Section: Methodsmentioning

confidence: 99%

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Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease

Chang

Xiao

Mercer‐Rosa

et al. 2018

Lupus

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Objectives: There are no population-based estimates of the incidence or risk factors for acute cardiac manifestations in children with systemic lupus erythematosus (SLE) to guide screening and diagnostic imaging practices. We estimated the incidence and prevalence of acute cardiac manifestations of child-onset SLE compared to adult-onset SLE and identified factors associated with cardiac diagnoses. Methods: We identified children (5–17 years) and adults (18–64) with incident SLE (≥3 ICD-9 codes 710.0, >30 days apart) using Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) de-identified U.S. administrative claims (2000–2013). We calculated incidence and prevalence of three outcomes: ≥1 diagnosis code for 1) pericarditis and/or myocarditis, 2) endocarditis or 3) valvular insufficiency. Negative binomial regression was used to identify characteristics associated with cardiac diagnoses in children and determine whether SLE onset in childhood versus adulthood was independently associated with cardiac involvement. Results: There were 297 children and 6927 adults with new-onset SLE. 17.8% of children had ICD-9 codes for acute cardiac diagnoses, the incidence of which were highest in the first year after SLE diagnosis (12.2 per 100 person-years). African American race (incidence rate ratio (IRR) 6.6, 95% CI [2.9, 15.0], p<0.01) and nephritis (IRR 7.0, 95% CI [2.6, 18.6], p<0.01) were associated with acute cardiac diagnoses in children. Child-onset disease was independently associated with a 4.4-fold higher rate of pericarditis or myocarditis compared to adult-onset SLE after adjustment for other disease and demographic characteristics (95% CI [2.4, 8.0], p<0.01). Conclusion: This study establishes baseline estimates of the incidence and prevalence of pericarditis and myocarditis in child-onset SLE, which is substantially higher than that of adultonset SLE. Prospective echocardiographic evaluations are needed to validate incidence measures and characterize the natural history of acute cardiac manifestations in child-onset SLE, as well as identify risk factors for poor cardiac outcomes to inform screening and management.

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Section: Methodsmentioning

confidence: 99%

“…SLE nephritis was identified using a validated algorithm, 11,12 and we have previously described methods for categorization of demographic characteristics and identification of other disease characteristics in this database. 13,18…”

Section: Methodsmentioning

confidence: 99%

Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease

Chang

Xiao

Mercer‐Rosa

et al. 2018

Lupus

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“…The median number of GP consultations increased during the 5-year interval preceding SLE diagnosis, i.e., from median 1 in the 48–54 months before diagnosis to 38 in the 0–12 months before diagnosis ( 42 ). Interestingly, a study performed in 682 children and young patients (aged 10–24 years) with SLE confirmed that they had significantly more health care visits than controls in the year before diagnosis with most (39%) visits occurring with primary care physicians ( 60 ). At 9–12 months prior to diagnosis, utilization of healthcare resources was almost 2-fold increased.…”

Section: When To Suspect Lupus In Primary Care?mentioning

confidence: 99%

“…“ Fever, unspecified ” and “ chest pain, unspecified ” symptoms were associated with shorter time to diagnosis. Notably, many young individuals with SLE carry psychiatric diagnoses prior to being diagnosed with SLE, which was also associated with increased pre-diagnosis healthcare use ( 60 ). Conclusively, a high index of suspicion of lupus is very important and in real-world primary care practice, SLE should be suspected in any patient who presents with unexplained manifestations involving two or more systems ( 61 ).…”

Section: When To Suspect Lupus In Primary Care?mentioning

confidence: 99%

Systemic Lupus Erythematosus in Primary Care: An Update and Practical Messages for the General Practitioner

Gergianaki

Βertsias

2018

Front. Med.

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Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease that manifests a wide range of organ involvement. Traditionally, the diagnosis and management of SLE is provided at secondary and tertiary centers to ensure prompt initiation of treatment, adequate control of flares and prevention of irreversible organ damage. Notwithstanding, the role of primary care in SLE is also emerging as there are still significant unmet needs such as the diagnostic delay at the community level and the high burden of therapy- and disease-related comorbidities. In the present review, we summarize practical messages for primary care physicians and general practitioners (GPs) concerning early diagnosis and proper referral of patients with SLE. In addition, we discuss the main comorbidities complicating the disease course and the recommended preventative measures, and we also provide an update on the role and current educational needs of GPs regarding the disease.

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“…10,11 As previously described, incident cases were defined as those who also had at least one year of claims data with no SLE codes in any position preceding the first primary or secondary SLE diagnosis code. 12 The date of SLE diagnosis was assigned as the first physician visit with a diagnosis code for SLE or the admission date of the first hospitalization with an SLE code, whichever came first. Individuals with pre-existing ICD-9 codes for congenital heart disease, bacterial endocarditis or rheumatic fever were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

Use of echocardiography at diagnosis and detection of acute cardiac disease in youth with systemic lupus erythematosus

Chang

Knight

Xiao

et al. 2018

Lupus

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Objectives There are no guidelines on the use of echocardiography to detect cardiac manifestations of childhood-onset systemic lupus erythematosus (SLE). We quantify the prevalence of acute cardiac disease in youth with SLE, describe echocardiogram utilization at SLE diagnosis, and compare regional echocardiogram use with incident cardiac diagnoses. Methods Using the Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) de-identified United States administrative database from 2000 to 2013, we identified youth ages 5-24 years with new-onset SLE (≥3 ICD-9 SLE codes 710.0, > 30 days apart) and determined the prevalence of diagnostic codes for pericardial disease, myocarditis, endocarditis, and valvular insufficiency. Multiple logistic regression was used to identify factors associated with echocardiography during the baseline period, up to one year before or six months after SLE diagnosis. We calculated a regional echocardiogram utilization index, which is the ratio of observed use over the mean predicted probability based on all available baseline characteristics. Spearman's rank correlation coefficient was used to evaluate the association between regional echocardiogram utilization indices and percentage of imaged youth diagnosed with their first cardiac manifestation following echocardiography. Results Among 699 youth with new-onset SLE, 18% had ≥ 1 diagnosis code for acute cardiac disease, of which valvular insufficiency and pericarditis were most common. Twenty-five percent of all youth underwent echocardiogram during the baseline period. Regional echocardiogram use was positively correlated with the percentage of imaged youth found to have cardiac disease (ρ = 0.71, p = 0.05). There was up to a five-fold difference in adjusted odds of baseline echocardiography between low- and high-utilizing regions (OR = 0.19, p = 0.007). Conclusion Nearly one-fifth of youth with new-onset SLE have acute cardiac manifestations; however, use of echocardiograms at SLE diagnosis is highly variable. There may be incremental diagnostic value to early use of echocardiography, but prospective studies are needed to determine whether greater use of echocardiograms modifies outcomes.

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High Health Care Utilization Preceding Diagnosis of Systemic Lupus Erythematosus in Youth

Cited by 18 publications

References 38 publications

Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease

Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease

Systemic Lupus Erythematosus in Primary Care: An Update and Practical Messages for the General Practitioner

Use of echocardiography at diagnosis and detection of acute cardiac disease in youth with systemic lupus erythematosus

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