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

Acute hospitalization in a cohort of patients with systemic sclerosis: a 10-year retrospective cohort study

This study aimed at analysing the causes and predictors of acute hospitalization and mortality in a cohort of SSc. Retrospective analysis of all acute hospital admissions of SSc patients fulfilling the 2013 EULAR/ACR Classification Criteria, from a single-centre cohort of 95 patients, between 2010 and 2020. The total number of SSc patients registered in our hospital, in this period, was 123. Clinical data were collected from medical files of our institution and from the National Healthcare Registry platform. 53 patients needed acute hospitalization, in a total of 164 admissions. The most frequent causes for admission were: infectious diseases [27%; 70% due to pneumoniae, of which 74% had SSc-associated interstitial lung disease (ILD)], cardiac disease (16.5%), peripheral vascular disease [12.8%; all due to digital ulcers], pulmonary hypertension (PH) (9.8%) and ILD (9.1%). There was an increase in admissions due to cardiac disease over the 10 years of follow-up, and a decrease of ILD over the last 5 years. Fourteen patients died (in-hospital mortality of 9%) mainly due to pneumoniae (36%), heart failure (21%), neoplastic diseases (21%), PH (14%) and ILD (7%). From all the admissions due to infection 70.5% were under immunosuppression at the time of the hospitalization. The frequency of acute admissions superior to 1 was associated with infection (OR 2.29, 95%CI 1.11-4.71). There were several factors associated with both acute admissions and mortality, including: gender, race, digital ulcers, cardiac dysfunction, ILD and PH. Infection was the principal cause of acute hospitalization and mortality, mainly due to pneumoniae. Although a high percentage of those had ILD, it has been decreasing in the last years in our cohort, as a direct cause of hospital admission and mortality, possibly reflecting the advances in its management.

Hospital readmission in systemic sclerosis associated pulmonary hypertension: Results from the PHAROS registry

OBJECTIVE

To identify individual-level factors associated with hospital readmission among individuals with systemic sclerosis associated pulmonary hypertension (SSc-PH).

METHODS

Individuals enrolled in the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma (PHAROS) registry contributed clinical data related to SSc-PH disease severity and hospital admissions. Readmission was defined as a subsequent hospitalization within 12 months of any hospital discharge. Characteristics were compared between individuals with and without readmissions using Fisher's exact test, Wilcoxon rank-sum test, or Kruskal Wallis test. Logistic regression was used to estimate associations between clinical predictors and likelihood of readmission.

RESULTS

Of 572 individuals with SSc-PH enrolled in PHAROS, 54% had ≥1 hospitalizations between 2005 and 2016. Among individuals ever-hospitalized, 34% had ≥1 readmission. Individuals with vs without readmissions had shorter median (IQR) time between index hospitalization date and next PHAROS visit (37 (3, 80) vs 81 (42, 136) days, p< 0.001). Index admissions related to PH or SSc (vs non-PH/SSc related) were associated with an increased odds of 12-month readmission (aOR 6.6 (95% CI 3.2, 13.6) and aOR 2.2 (95% CI 1.1, 4.5), respectively). Readmission was less likely among home oxygen users (vs non-users) (aOR 0.44; 95% CI 0.22, 0.89). Race, age, sex, disease duration, and disease subtype were not associated with readmission.

CONCLUSION

The strongest predictor for 12-month readmission was an index hospitalization reason related to PH. Home oxygen use was associated with lower odds of readmission. Future studies should determine whether testing for the need for home oxygen mediates the risk of readmission in SSc-PH.

Incidence and prevalence of systemic sclerosis globally: a comprehensive systematic review and meta-analysis

OBJECTIVES

We aimed to conduct a systematic review and meta-analysis on the incidence and prevalence of SSc covering the entire literature.

METHODS

This study followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement of 2009. We conducted a systematic search in MEDLINE, Web of Science and Embase to identify articles reporting incidence and/or prevalence of SSc. Two authors conducted the search, reviewed articles for inclusion and extracted relevant data. We used random-effects models to estimate the pooled prevalence and incidence of SSc and performed subgroup analyses by sex, case definition and region to investigate heterogeneity. We explored the association between calendar period and reported estimates using meta-regression.

RESULTS

Among 6983 unique records identified, we included 61 studies of prevalence and 39 studies of incidence in the systematic review. The overall pooled prevalence of SSc was 17.6 (95% CI 15.1, 20.5) per 100 000 and the overall pooled incidence rate of SSc was 1.4 (95% CI 1.1, 1.9) per 100 000 person-years. We observed significant regional variations in reported estimates; studies conducted in North America reported considerably higher estimates than other regions. The pooled incidence and prevalence in women were five times higher than in men. More recent studies reported higher estimates than older ones.

CONCLUSION

In this comprehensive review of the incidence and prevalence of SSc across the world, there was large heterogeneity among estimates, which should be taken into consideration when interpreting the results.

Incidence, prevalence and mortality of systemic sclerosis in Italy: a nationwide population-based study using administrative health data

To study incidence, prevalence and mortality of systemic sclerosis (SSc) in Italy, assessing epidemiological differences between men and women and in distinct age groups. We performed a nationwide population-based study using administrative health data from regional co-payment exemption registries. Patients entitled with SSc-specific co-payment exemption were included. Fourteen of the 20 Italian regions contributed data covering a population of over 45 million individuals. Crude annual incidence rate, annual prevalence, crude annual mortality rate and standardised mortality ratio (SMR) were calculated. In 2016, the overall crude incidence rate of SSc was 18.5 (95% CI 16.9-20.2) per million per year. Incidence rate was 31.0 (95% CI 28.1-34.1) per million in women, and 4.3 (95% CI 3.2-5.6) per million in men. Peak incidence was observed in the age range 55-69 years. Overall annual prevalence was 306.1 (95% CI 301.1-311.2) per million. Prevalence was 530.8 (95% CI 521.5-540.2) per million in women and 67.8 (95% CI 64.4-71.3) per million in men, with a female to male ratio of 7.8:1. Highest prevalence was observed in the range 70-84 years. Crude annual mortality rate was 27.9 (95% CI 24.9-31.1) per 1000 patients. Overall SMR in patients with SSc was 2.8 (95% CI 1.9-3.8). SMR was 3.8 (95% CI 2.9-5.1) in men and 2.6 (95% CI 1.8-3.6) in women. We provided updated estimates on epidemiology of SSc in Italy. Our findings on incidence, prevalence and mortality of SSc are consistent with previously published literature.

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

AIM

To investigate secular trends and regional disparities in hospitalizations due to systemic connective tissue diseases (SCTD) in Sweden from 1998 to 2016.

METHOD

We identified all hospital admissions with a principal diagnosis of SCTD (ICD-10 codes: M30-M36) from the Swedish National Patient Register. Joinpoint regression was used to assess secular trends in age-standardized hospitalization rates (ASHR) and proportions of SCTD from all and musculoskeletal disorders hospitalizations. We also assessed the secular trends in the absolute and relative regional disparities of SCTD hospitalizations.

RESULTS

We identified 89 333 SCTD hospitalizations (0.3% of all hospitalizations), of these about 69% were for women and 49% of patients were aged 15-64 years. Polyarteritis nodosa and related conditions (PANRC) and systemic lupus erythematosus (SLE) were the most frequent SCTD among those aged <10 years and 10-54 years, respectively. Joinpoint regression suggested that both rates and proportions of SCTD hospitalizations declined over time. These trends persisted among sex, age and diagnosis subgroups except for PANRC in patients aged 0-19 years who observed an average annual increase of 3.4% (95% CI: 1.8, 5.1) over the study period. There were 2.4-fold (95% CI: 2.3-2.5) difference between the regions with the highest and lowest mean ASHR. There was no statistically significant secular trend in the relative regional disparities, whereas the absolute regional disparity declined over time.

CONCLUSION

There were substantial decreases in the absolute and relative burden of SCTD hospitalizations reflecting possible improvements in disease management in Sweden. The rising trend in PANRC among the youngest children warrants further investigation.

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

OBJECTIVE

Systemic sclerosis (SSc) is an uncommon non-hereditary sporadic disease that increases the risk of premature death, especially in diffuse type. We determined the prevalence of SSc in the last 13 years in our rheumatologic hospitals as a referral center for southern Iranian patients, the causes of hospitalization, the average length of stay (LOS), the mortality rate, and the reason for their mortality.

MATERIAL AND METHODS

A cross-sectional study was performed in Shiraz University of Medical Sciences, Iran. The studied population included all patients diagnosed with systemic sclerosis. We calculated the hospitalization rates, in-hospital mortality rates, and mean LOS.

RESULTS

There were 446 admissions by 181 patients with SSc. The female to male ratio was about 10.7 : 1. The overall mean LOS was 5.95 days. Digital ulcer and interstitial lung disease (ILD) were the most common causes of hospitalizations among the SSc-related events. For those with a non-SSc-related condition, infection was the most prevalent event. Most of the deaths were due to ILD and pulmonary artery hypertension(PAH), and the overall in-hospital mortality rate was 16.5%.

CONCLUSIONS

Women with SSc had higher rates of hospitalization but lower in-hospital mortality than men.There were some differences between our study and other similar studies in the causes of hospitalization and in-hospital death among SSc patients, especially the lower age of death. The patients with digital ulcers and those with intestinal lung disease or pulmonary hipertension were most commonly admitted to the hospital in our study group. Probably, increasing the skin care of these patients and asking other specialty groups to cooperate will decrease the high rate of hospitalizations in our population.

Home tele-rehabilitation for rheumatic patients: impact and satisfaction of care analysis

Introduction

In this paper, we evaluated patients’ perspectives on the use of a system for home tele-rehabilitation, designed for subjects with low computer literacy suffering hand impairment due to rheumatic diseases.

Methods

After a clinical trial assessing device effectiveness, the Psychosocial Impact of Assistive Devices Scale (PIADS), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and Individually Prioritised Problem Assessment (IPPA) questionnaires were administered to evaluate the system’s impact on each patient’s life, and the results were correlated with clinical indices. Patients were asked to continue self-administered rehabilitation with common objects. One year later, a semi-structured telephone interview gathered data on their experience.

Results

The system received a positive QUEST score (4.5 ± 0.3) and a modest PIADS score (0.84 ± 0.8) due to the small impact on adaptability and self-esteem. The IPPA (3.7 ± 3.4) revealed improvement in the ability to perform tasks considered important, which was significantly correlated ( r = 0.60; p < 0.02) with the clinical Health Assessment Questionnaire (HAQ) index improvement. The interviews revealed a positive engagement effect, enhanced by the need to develop skills to be able to use the device (technological challenge) and by the perception of more attention by the medical staff. This may explain the significant dropout rate (80%) from the post-trial rehabilitation of the patients who used the device.

Discussion

The system was largely accepted by the patients. The results suggest that the need for information on their rehabilitation progress and the technological challenge deserves further study to make patients more autonomous in cases of continuous rehabilitation.