Sage Journals: Discover world-class research

Abstract

Objectives

Systemic lupus erythematosus (SLE) is a chronic, multisystemic, immune-mediated disorder associated with a substantial hospitalization risk. As a comparatively rare disease, there is a sparsity of research examining the burden of hospital admission in the contemporary era. We aim to describe national trends in hospitalization rates in England between 1998 and 2015 for SLE, using rheumatoid arthritis (RA) and general population rates as comparison cohorts for benchmarking.

Methods

Hospital admission rates, emergency and day-case admission rates, length of stay and bed days used were calculated using finished consultant episodes from Hospital Episode Statistics data. Cochran-Armitage tests and linear regression quantified the significance and magnitude of change over time.

Results

SLE admissions increased from 8.97 to 9.04 per 100,000 (p < 0.001) between 1998 and 2015. By comparison, RA admissions rose from 71.0 to 171.6 per 100,000 (p < 0.001) and all-cause admissions rose from 24,500 to 34,500 per 100,000 (p < 0.001). Emergency admissions decreased both for SLE (2.6 to 1.2 per 100,000) and RA (12.8 to 4.4 per 100,000) despite all-cause emergency admissions increasing from 9400 to 10,300 per 100,000. SLE and RA day cases increased, whilst median length of stay decreased. Despite increasing admissions, total bed days for SLE and RA fell by 60% and 90%, respectively.

Conclusions

Whilst all-cause emergency admissions rose in the general population, those for SLE fell. Length of stay and bed days reduced and day cases increased, probably reflecting changing therapeutic strategies. This potentially large reduction in resource utilization warrants consideration when assessing the impact of new therapies.

Keywords

Admissions health policy hospitalization rheumatoid arthritis systemic lupus erythematosus

Get full access to this article

View all access options for this article.

References

Chan

Dekis

Clarke

et al.

Hospitalizations in patients with systemic lupus erythematosus: Updated analyses from 2006 to 2011. Arthritis Res Ther 2012; 14(Suppl 3): A59–A59.

Wolfe

Kleinheksel

Spitz

et al.

A multicenter study of hospitalization in rheumatoid arthritis. Frequency, medical-surgical admissions, and charges. Arthritis Rheum 1986; 29: 614–619.

Cervera

Khamashta

Font

et al.

Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003; 82: 299–308.

Michet

3rd Strobova

Achenbach

Crowson

Matteson

. Hospitalization rates and utilization among patients with rheumatoid arthritis: A population-based study from 1987 to 2012 in Olmsted County, Minnesota. Mayo Clin Proc 2015; 90: 176–183.

Lee

Dhillon

Pope

. All-cause hospitalizations in systemic lupus erythematosus from a large Canadian referral centre. Rheumatology 2013; 52: 905–909.

Yazdany

Marafino

Dean

et al.

Thirty-day hospital readmissions in systemic lupus erythematosus: Predictors and hospital and state-level variation. Arthritis Rheum 2014; 66: 2828–2836.

Gladman

Urowitz

. Hospitalizations in patients with systemic lupus erythematosus in an academic health science center. J Rheumatol 2017; 44: 1173–1178.

Mak

Cheung

Chiew

Liu

. Global trend of survival and damage of systemic lupus erythematosus: Meta-analysis and meta-regression of observational studies from the 1950s to 2000s. Semin Arthritis Rheum 2012; 41: 830–839.

Urowitz

Gladman

Tom

Ibañez

Farewell

. Changing patterns in mortality and disease outcomes for patients with systemic lupus erythematosus. J Rheumatol 2008; 35: 2152–2158.

10.

Turesson

Jacobsson

Bergström

. Extra-articular rheumatoid arthritis: Prevalence and mortality. Rheumatology (Oxford) 1999; 38: 668–674.

11.

Blunt I, Bardsley M, Dixon J. Trends in emergency admissions in England 2004–2009. Nuffield Trust. https://www.nuffieldtrust.org.uk/research/trends-in-emergency-admissions-in-england-2004-2009 (accessed 5 July 2010).

12.

Piga

Casula

Perra

et al.

AB1141 Population-based analysis of hospitalizations in a West-European region revealed major changes in hospital utilization for patients with systemic lupus erythematosus over the period 2001–2012. Ann Rheum Dis 2015; 74: 1283–1283.

13.

Collings

Highton

. Changing patterns of hospital admissions for patients with rheumatic diseases. N Z Med J 2002; 115: 131–132.

14.

Lim

Fisher

et al.

Hospitalization trends of rheumatoid arthritis and gout in the United States: A crossroad. Arthritis Rheum 2015; 67: 2433–2435.

15.

Ward

. Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983–2001. Arthritis Rheum 2004; 50: 1122–1131.

16.

O’Sullivan

Bateman

Jobanputra

. Acute rheumatology referrals are increasing: A service evaluation of more than 1000 consecutive acute inpatient referrals from a tertiary centre. Rheumatology (Oxford) 2016; 55(Suppl 1): i131–i132.

17.

Singh

Wells

Christensen

et al.

Adverse effects of biologics: A network meta-analysis and Cochrane overview. Cochrane Database Syst Rev 2011, pp. CD008794–CD008794.

18.

Rosman

Shoenfeld

Zandman-Goddard

. Biologic therapy for autoimmune diseases: An update. BMC Med 2013; 11: 88–88.

19.

Health and Social Care Information Centre. Hospital episode statistics (HES) analysis guide. http://content.digital.nhs.uk/media/1592/HES-analysis-guide/pdf/HES_Analysis_Guide_Jan_2014.pdf (accessed 1 March 2015).

20.

Williams

Mann

. Hospital episode statistics: Time for clinicians to get involved? Clin Med (Lond) 2002; 2: 34–37.

21.

Office for National Statistics. England population estimates 1971 to 2014. User requested data: Reference number 004359. (accessed 6 July 2016).

22.

Uramoto

Michet

Jr Thumboo

Sunku

O’Fallon

Gabriel

. Trends in the incidence and mortality of systemic lupus erythematosus, 1950–1992. Arthritis Rheum 1999; 42: 46–50.

23.

Voss

Green

Junker

. Systemic lupus erythematosus in Denmark: Clinical and epidemiological characterization of a county-based cohort. Scand J Rheumatol 1998; 27: 98–105.

24.

Rees

Doherty

Grainge

Davenport

Lanyon

Zhang

. The incidence and prevalence of systemic lupus erythematosus in the UK, 1999–2012. Ann Rheum Dis 2016; 75: 136–141.

25.

European Medicines Agency. https://www.ema.europa.eu/ (accessed 21 June 2018).

26.

Ward

. Avoidable hospitalizations in patients with systemic lupus erythematosus. Arthritis Rheum 2008; 59: 162–168.

27.

Purdy S. Avoiding hospital admissions: What does the research evidence say? King’s Fund Publication. December 2010. https://www.kingsfund.org.uk/publications/avoiding-hospital-admissions (accessed 23 May 2019).

28.

Myasoedova

Crowson

Kremers

Therneau

Gabriel

. Is the incidence of rheumatoid arthritis rising?: Results from Olmsted County, Minnesota, 1955–2007. Arthritis Rheum 2010; 62: 1576–1582.

29.

Harty

O’Toole

FitzGerald

. Profound reduction in hospital admissions and musculoskeletal surgical procedures for rheumatoid arthritis with concurrent changes in clinical practice (1995–2010). Rheumatology (Oxford) 2015; 54: 666–671.

30.

Atzinger

Guo

. Biologic disease-modifying antirheumatic drugs in a national, privately insured population: Utilization, expenditures, and price trends. Am Health Drug Benefits 2017; 10: 27–36.

31.

Shourt

Crowson

Gabriel

Matteson

. Orthopedic surgery among patients with rheumatoid arthritis 1980–2007: A population-based study focused on surgery rates, sex, and mortality. J Rheumatol 2012; 39: 481–485.

32.

Kahlenberg

Fox

. Advances in the medical treatment of rheumatoid arthritis. Hand Clin 2011; 27: 11–20.

33.

Ginsburg

Koretz

. Bed availability and hospital utilization: Estimates of the “Roemer effect”. Health Care Financ Rev 1983; 5: 87–92.

34.

Blatchford

Capewell

. Emergency medical admissions: Taking stock and planning for winter. BMJ 1997; 315: 1322–1323.

35.

Delamater

Messina

Grady

WinklerPrins

Shortridge

. Do more hospital beds lead to higher hospitalization rates? A spatial examination of Roemer’s law. PLoS One 2013; 8: e54900–e54900.

36.

Rosano

Loha

Falvo

et al.

The relationship between avoidable hospitalization and accessibility to primary care: A systematic review. Eur J Public Health 2012; 23: 356–360.

37.

Weinberger

Oddone

Henderson

. Does increased access to primary care reduce hospital readmissions? N Engl J Med 1996; 334: 1441–1447.

38.

Burns

Rigby

Mamidanna

et al.

Systematic review of discharge coding accuracy. J Public Health (Oxf) 2012; 34: 138–148.

39.

Audit Commission. Right data, right payment. Annual report on the payment by results data assurance programme (2011, accessed 12 August 2012).

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.93 MB

0.26 MB

Changing hospitalization trends for systemic lupus erythematosus and rheumatoid arthritis in England

Abstract

Objectives

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material