Risks, Subtypes, and Hospitalization Costs of Stroke Among Patients with Systemic Lupus Erythematosus: A Retrospective Cohort Study in Taiwan

Wang, I‐Kuan; Muo, Chih‐Hsin; Chang, Yen Jung; Liang, Ching‐Chung; Lin, S.-C.; Chang, Chiz‐Tzung; Yen, Tzung‐Hai; Chuang, Feng‐Rong; Chen, Pei–Chun; Huang, Chiu-Ching; Sung, Fung‐Chang

doi:10.3899/jrheum.111510

Cited by 28 publications

(44 citation statements)

References 27 publications

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“…Previous studies have demonstrated that both are higher in patients with SLE compared to controls (5,10,19,20). The current study confirms this observation, but also demonstrates a consistent change in the pattern of utilization over the 13 years of observation.…”

Section: Discussionsupporting

confidence: 89%

“…Studies of health care utilization have consistently found that it is higher in SLE patients than in comparator groups of patients (4,5,10,16). Utilization may be influenced by a variety of factors, including disease severity (17) (higher in lupus nephritis [8,16] and neuropsychiatric lupus [11,16]), race and ethnicity (lower in Hispanics [18]), and the type of health care delivery (higher in the fee-for-service system [3]).…”

Section: Discussionmentioning

confidence: 99%

“…Different research methodologies have been used to address this, including case-control strategies in tertiary referral centers, observational cohorts, and population health administrative data sets. Resource utilization and associated costs have been examined in various geographic locations, including the US (2-7), Canada (8), and other countries (9)(10)(11). This is appropriate, as findings are influenced by health care system delivery, which is highly variable.…”

Section: Introductionmentioning

confidence: 99%

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Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

Hanly

Thompson

Skedgel

2016

Arthritis Care & Research

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Objective. To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of systemic lupus erythematosus (SLE) cases and matched control patients over 13 years. Methods. A retrospective cohort study was performed utilizing administrative health care data from approximately 1 million people with access to universal health care. Using International Classification of Diseases, Ninth and Tenth Revisions diagnostic codes, 7 SLE case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years.Results. The number of incident SLE cases varied from 564 to 4,494 depending on the case definition used. The mean age varied from 47.7 to 50.6 years and the proportion of females from 78.0% to 85.1%. SLE utilization of physicians was highest in the index year, and declined significantly thereafter for all case definitions. By the fourth year, encounters with subspecialty physicians fell by 60% (rheumatologists), 50% (internists), and 31% (other physicians). In contrast, visits to family physicians fell by only 9%. Visits to the ER and hospital admissions for SLE cases were also more frequent early in the disease course and fell significantly over the study for both ER visits (all case definitions) and hospitalizations (2 of 7 case definitions). Conclusion. In SLE patients, health care utilization is highest in the first few years following the diagnosis, which is also the time of maximal involvement by rheumatologists. Utilization declines over time, and encounters with patients' family physicians predominate over those of other physician groups.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

Hanly

Thompson

Skedgel

2016

Arthritis Care & Research

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“…Taiwan began its National Health Insurance (NHI) program on March 1, 1995, in order to provide comprehensive health care to all citizens of Taiwan. As of December 2007, 22.6 million individuals, representing 98% of the Taiwanese population, had been enrolled in the program [8, 19]. The data on NHI claims include comprehensive demographic data, dates of clinical visits, and diagnostic codes, as well as details of prescriptions, examinations, and procedures, which are entered into the NHIRD; it is maintained by the Bureau of National Health Insurance, Taiwan.…”

Section: Methodsmentioning

confidence: 99%

Association between Autoimmune Rheumatic Diseases and the Risk of Dementia

Wang

Yeh

et al. 2014

BioMed Research International

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Aim. Autoimmune rheumatic diseases (ARD) are characterized by systemic inflammation and may affect multiple organs and cause vascular events such as ischemic stroke and acute myocardial infarction. However, the association between ARD and increased risk of dementia is uncertain. This is a retrospective cohort study to investigate and compare the risk of dementia between patients clinically diagnosed with ARD and non-ARD patients during a 5-year follow-up period. Methods. Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID2000). We included 1221 patients receiving ambulatory or hospitalization care and 6105 non-ARD patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied for 5 years to identify the subsequent manifestation of dementia. The data obtained were analyzed by Cox proportional hazard regression. Results. During the 5-year follow-up period, 30 ARD (2.48%) and 141 non-ARD patients (2.31%) developed dementia. During the 5-year follow-up period, there were no significant differences in the risks of any type of dementia (adjusted hazard ratio (HR), 1.18; 95% CI, 0.79–1.76) in the ARD group after adjusting for demographics and comorbidities. Conclusions. Within the 5-year period, patients with and without ARD were found to have similar risks of developing dementia.

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“…To address this, we used the results from our meta-analysis on stroke risk associated with SLE11 and included our estimate in the pooled result to update the analysis. Pooling our study with Mok et al 12 and Wang et al 13 (not including Zöller et al 14 because their data overlap with ours), the relative risk of stroke is 2.11 (1.22, 3.65), with I 2 of 49% and P for heterogeneity of 0.14. This indicates that SLE is associated with haemorrhagic stroke.…”

mentioning

confidence: 73%

Response to: ‘Increased stroke incidence in systemic lupus erythematosus patients: risk factors or disease itself?’ by Bruzzese and Zullo

et al. 2017

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Risks, Subtypes, and Hospitalization Costs of Stroke Among Patients with Systemic Lupus Erythematosus: A Retrospective Cohort Study in Taiwan

Abstract: Stroke risk and hospital care costs are considerably greater for patients with SLE than without. The relative risk of stroke is the highest in young patients with SLE.

Cited by 28 publications

References 27 publications

Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

Association between Autoimmune Rheumatic Diseases and the Risk of Dementia

Response to: ‘Increased stroke incidence in systemic lupus erythematosus patients: risk factors or disease itself?’ by Bruzzese and Zullo

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