The Detection of Rheumatic Disease through Hospital Diagnoses with Examples of Rheumatoid Arthritis and Giant Cell Arteritis: What Are We Missing?

Michet, Clement J.; Crowson, Cynthia S.; Achenbach, Sara J.; Matteson, Eric L.

doi:10.3899/jrheum.150186

Cited by 6 publications

(2 citation statements)

References 12 publications

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“…However, GPA case definitions for hospitalization and mortality trends were limited to principal discharge diagnoses, which have been shown to substantially improve the validity of the case definition and thus minimize misclassification bias(13, 14). Similarly, there may have been cases of GPA which were coded under alternative ICD-9 code(s)(15). NIS data is de-identified so the unit of analysis is each hospitalization; as such, one cannot rule out the possibility that the observed mortality reductions are a reflection of multiple, shorter hospitalizations in a given year for the same patient who ultimately dies.…”

Section: Discussionmentioning

confidence: 99%

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Wallace

Miloslavsky

et al. 2017

Arthritis Care & Research

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Background Granulomatosis with polyangiitis (GPA) is a type of ANCA-associated vasculitis associated with severe end-organ damage and treatment-related complications that often lead to hospitalization and death. Nationwide trends in hospitalizations and in-hospital mortality over the past two decades are unknown and were evaluated in this study. Methods Using the National Inpatient Sample (NIS), the largest all-payer inpatient database in the US, the trends in hospitalizations with a discharge diagnosis of GPA (formerly Wegener’s granulomatosis; ICD-9-CM: 446.4) between 1993 and 2011 were studied. Analyses were performed using hospital-level sampling weights to obtain US national estimates. Results From 1993 to 2011, the annual hospitalization rate for patients with a principal diagnosis of GPA increased by 24% from 5.1 to 6.3/1,000,000 US persons (P-for-trend<0.0001); however, their in-hospital deaths declined by 73% from 9.1% to 2.5% (P-for-trend<0.0001), resulting in a net 66% reduction of the annual in-hospital mortality rate. The median length of stay declined by 20% from 6.9 days in 1993 to 5.5 days in 2011 (P-for-trend=0.0002). Infection was the most common principal discharge diagnosis when GPA was a secondary diagnosis, including among those who died during hospitalization. Conclusion The findings from these nationally representative, contemporary, inpatient data indicate that in-hospital mortality of GPA has declined substantially over the past two decades while the overall hospitalization rate for GPA increased slightly. Infection remains a common principal hospitalization diagnosis among GPA patients, including hospitalizations resulting in mortality.

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Section: Discussionmentioning

confidence: 99%

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Wallace

Miloslavsky

et al. 2017

Arthritis Care & Research

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“…18 In three Minnesota hospitals, RA was recorded in 55% of hospitalizations of patients with RA. 19 Whether the sensitivity of hospitalization diagnoses is also low for other types of inflammatory arthritis, or if the sensitivity and specificity varies with the reason for hospitalization, is unclear. Importantly, it is not known if any misclassification may bias comparisons of hospital outcomes between patients with and without inflammatory arthritis.…”

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confidence: 99%

Accuracy of diagnoses of inflammatory arthritis in administrative hospitalization databases

Ward

2020

Pharmacoepidemiology and Drug

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PurposeStudies using administrative hospitalization data often classify patients as having inflammatory arthritis based on diagnoses recorded at the hospitalization. We examined the agreement of these diagnoses with patients' prior medical histories.MethodsWe identified Medicare beneficiaries hospitalized in 2011 to 2015 for total hip arthroplasty (THA), total knee arthroplasty (TKA), acute myocardial infarction (AMI), or sepsis. We compared diagnoses of rheumatoid arthritis (RA) or ankylosing spondylitis (AS) at the index hospitalization to diagnoses over prior inpatient and outpatient claims. To assess the impact of potential misclassification, we compared hospital outcomes using the alternative methods of detecting beneficiaries with arthritis. Analyses were repeated using Medicaid data.ResultsAmong 506 781 Medicare beneficiaries with THA, 18282 had RA and 571 had AS at the arthroplasty hospitalization, while 13 212 had RA and 1519 had AS based on claims history. Diagnoses at the hospitalization were highly specific (0.98‐0.99), but sensitivities (0.65 for RA; 0.31 for AS) and positive predictive values (PPV) (0.47 for RA; 0.83 for AS) were lower. For TKA, AMI, and sepsis, specificities were 0.97 to 0.99, sensitivities 0.60 to 0.66 for RA and 0.18 to 0.22 for AS, and PPVs 0.43 to 0.47 for RA and 0.73 to 0.77 for AS. In Medicaid, sensitivities were 0.21 to 0.67 for RA and 0.07 to 0.49 for AS. Frequencies of some hospital outcomes differed when arthritis was classified by the index hospitalization or claims history.ConclusionDiagnoses of RA and AS in hospitalization databases are highly specific but fail to identify large proportions of patients with these diagnoses.

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Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

Esposito

Bonanni

Maggi

et al. 2016

Human Vaccines & Immunotherapeutics

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Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research.

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The Detection of Rheumatic Disease through Hospital Diagnoses with Examples of Rheumatoid Arthritis and Giant Cell Arteritis: What Are We Missing?

Cited by 6 publications

References 12 publications

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Accuracy of diagnoses of inflammatory arthritis in administrative hospitalization databases

Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

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