Population-based analysis of hospitalizations for patients with systemic sclerosis in a West-European region over the period 2001–2012

Abstract

The aim of this study was to evaluate systemic sclerosis (SSc) hospitalizations through a retrospective population-based study analyzing administrative data during 2001-2012 in Sardinia, an Italian region with universal Health System coverage. Data on hospital discharge records with ICD-9-CM code for SSc (710.1) were obtained from the Department of Health and Hygiene. Two-tailed Cochran-Armitage test for trend was applied to analyze the annual trend for primary and non-primary discharge diagnoses. SSc prevalence was also estimated. This study included 4981 hospitalizations in 736 patients (84.8 % women). Hospitalizations with SSc as primary diagnosis were 3631 (72.9 %). Their annual number significantly increased during study period, from 143 in 2001 to 390 in 2012. Annual trend analysis revealed statistically significant increase in number and percentage of interstitial lung disease (p < 0.0001), pulmonary arterial hypertension (p < 0.0024), osteoporotic fragility fractures (p < 0.0001), ulcers, and gangrene (p = 0.0037) as non-primary diagnoses associated with SSc. Although the number of admissions with SSc as non-primary diagnosis showed a slight reduction during the study period, the annual number and percentage of admissions with respiratory failure (p = 0.0016) and congestive heart failure (p < 0.0001) as primary diagnosis showed a significant upward trend. Admissions for intravenous infusion, mainly day-hospital, accounted for 19.1 % of all hospitalizations for SSc and showed a significant (p = 0.0002) upward trend in 2001-2012. The 2012 SSc prevalence in Sardinia was estimated to be 34.8 per 100,000 inhabitants. Hospital care utilization for SSc is changing over time, showing increased hospitalizations aimed at the early recognition and treatment for the major manifestations and complications of SSc.

Assessment of hospitalization and mortality of scleroderma in-patients: a thirteen-year study

“…In a study done by Wielosz et al [ 11 ] on European Caucasian patients, this ratio was 3.1 : 1. Although in a study done in Italy (Sardinia) on 4981 hospitalizations in 2001–2012, the women’s admissions was 84.8% that was nearly the same as our patients [ 12 ].…”

“…CHF, acute myocardial infarction (MI), dysrhythmias] were the principal cause of hospitalization in SSc patients (21.9%), followed by diseases of the gastrointestinal (12.7%), musculoskeletal (12.0%) and respiratory (11.5%) systems; PAH and infection were the 14 th and 8 th most common diagnoses. In the study by Piga et al [ 12 ] ILD was the most common scleroderma-related causes of admissions and infection was the most common non-scleroderma cause. Their second scleroderma-related cause was procedures(intravenous treatments) that in our patients with digital ulcers was also the main cause of admissions for receiving prostaglandins and we included them as digital ulcer causes.…”

“…Their second scleroderma-related cause was procedures(intravenous treatments) that in our patients with digital ulcers was also the main cause of admissions for receiving prostaglandins and we included them as digital ulcer causes. So, maybe the main causes in our patients were relatively the same [ 12 ].…”

Hospitalizations due to systemic connective tissue diseases: Secular trends and regional disparities in Sweden, 1998‐2016

“…Very few studies have investigated secular trends in a specific SCTD and the findings have been mixed. For instance, hospitalizations for SSc were reported as declining in the USA between 1999 and 2011 but rose in Sardinia (Italy) from 2001 to 2012 . Furthermore, hospitalizations for SLE were stable among people aged 2‐21 years in the USA during 2000‐2009, but declined in Sardinia (Italy) between 2001 and 2012 .…”

“…A recent study estimated that 58% of total healthcare costs of Swedish patients with SLE were attributed to hospitalization . Despite this, very few studies investigated secular trends in hospitalization for a specific SCTD (eg, SLE, SSc, granulomatosis with polyangiitis [GPA]) and to our knowledge, no study has assessed secular trends of hospitalizations for SCTD and its sub‐diagnoses in a single study using the same data source and uniform methodology. Considering improvements in management of SCTD in recent decades, such analysis can assist evaluating the effectiveness of these improvements, helping to understand changes in burden and management of the disease, and aid informed healthcare planning.…”