The Accuracy of Self-report in Rheumatic Diseases

Prevalence of autoimmune conditions in pregnant women in a tertiary maternity hospital: A cross-sectional survey and maternity database review

Background

Autoimmune conditions are associated with adverse pregnancy and offspring outcomes; however, the prevalence in pregnant women is not well understood. Estimates based on administrative data alone may underestimate prevalence.

Methods

A cross-sectional survey of women attending a tertiary referral hospital for antenatal care in December 2018-February 2019 and review of the hospital's maternity database of women giving birth from October 2017-June 2018 to estimate autoimmune disease prevalence.

Results

A total of 400 women completed surveys (78% response rate) and 41 (10.3%) reported an autoimmune disease, most commonly Hashimoto's thyroiditis (2.8%) and psoriasis (2.5%). From the maternity database, 112 of 2756 women giving birth (4.1%) had a recorded autoimmune disease, most commonly Hashimoto's thyroiditis (1.3%) followed by coeliac disease, Graves' disease, and immune thrombocytopenic purpura (all 0.4%).

Conclusion

Autoimmune disease prevalence in pregnant women is higher when self-reported and may be more common than previously reported using administrative data.

Impact of musculoskeletal conditions among those in residential aged care in Australia

OBJECTIVE

To determine the prevalence of musculoskeletal conditions, co-morbidity and functional limitations in older people in residential aged care in Australia and the association of musculoskeletal conditions with mortality.

METHODS

A retrospective cohort study using data from 490 325 people in the Registry of Senior Australians was conducted between 2004 and 2014. The association of co-morbidity, health risk factors and functional limitations with musculoskeletal conditions was evaluated using logistic regression. Cox regression was used to examine the association with mortality.

RESULTS

Overall, 40.2% [95% CI 40.1-40.4]) of residents had a musculoskeletal condition, which was associated with limited social (OR 1.16 [95% CI 1.14-1.19]) and domestic activities (OR 1.44 [95% CI 1.39-1.49]). Residents with musculoskeletal conditions had a 15% lower risk of mortality (aHR 0.85 [95% CI 0.85-0.86], P < 0.001) compared to residents without.

CONCLUSION

The presence of musculoskeletal conditions in older people in residential aged care negatively impacts activities of daily living and quality of life rather than mortality.

The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study

This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.

Improving accuracy of self-reported diagnoses of rheumatoid arthritis in the French prospective E3N-EPIC cohort: a validation study

OBJECTIVES

The French E3N-EPIC (Etude Epidémiologique auprès des femmes de la Mutuelle générale de l'Education Nationale-European Prospective Investigation into Cancer and Nutrition) cohort enrolled 98 995 women aged 40 to 65 years at inclusion since 1990 to study the main risk factors for cancer and severe chronic conditions in women. They were prospectively followed with biennially self-administered questionnaires collecting self-reported medical, environmental and lifestyle data. Our objective was to assess the accuracy of self-reported diagnoses of rheumatoid arthritis (RA) and to devise algorithms to improve the ascertainment of RA cases in our cohort.

DESIGN

A validation study.

PARTICIPANTS

Women who self-reported an inflammatory rheumatic disease (IRD) were asked to provide access to their medical record, and to answer an IRD questionnaire. Medical records were independently reviewed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Positive predictive values (PPV) of self-reported RA alone, then coupled with the IRD questionnaire, and with a medication reimbursement database were assessed. These algorithms were then applied to the whole cohort to ascertain RA cases.

RESULTS

Of the 98 995 participants, 2692 self-reported RA. Medical records were available for a sample of 399 participants, including 305 who self-reported RA. Self-reported RA was accurate only for 42% participants. Combining self-reported diagnoses to answers to a specific IRD questionnaire or to the medication reimbursement database improved the PPV (75.6% and 90.1%, respectively). Using the devised algorithms, we could identify 964 RA cases in our cohort.

CONCLUSION

Accuracy of self-reported RA is poor but adding answers to a specific questionnaire or data from a medication reimbursement database performed satisfactorily to identify RA cases in our cohort. It will subsequently allow investigating many potential risk factors of RA in women.

Multimorbidity in patients with chronic migraine and medication overuse headache

OBJECTIVES

Patients with chronic migraine (CM) display a considerable amount of comorbidities, particularly psychiatric and cardiovascular, and the presence of multiple comorbidities, that is, the so-called multimorbidity, is a risk factor for migraine chronification or maintenance of CM. Our aim was to address the rate and impact of multimorbidity in patients with CM and medication overuse headache (MOH).

MATERIALS & METHODS

In a sample of patients with CM attending a structured withdrawal for coexisting MOH, we defined multimorbidity as the presence of two or more conditions in addition to CM-MOH. We compared patients with and without multimorbidity for demographic and clinical variables, quality of life, and disability; we also tested whether patients with multimorbidity had higher likelihood to attend emergency room, relapse into CM, and require further withdrawal treatments by 12 months.

RESULTS

One hundred and ninety-four patients were enrolled as follows: 61% had at least one comorbidity, the most common being mental (34%), circulatory (18%), and endocrine conditions (13%); 32% were multimorbidity cases. Patients with multimorbidity had higher headaches frequency, older age, lower education and lower employment rates, higher disability and lower QoL. They were more frequently opioids/barbiturates overusers and were more likely to attend ER (OR: 2.36), relapse into CM (OR: 2.19), and undergo another withdrawal (OR: 2.75) by 12 months after discharge, after controlling for age, gender, years of education, and headache frequency.

CONCLUSIONS

Recognizing multimorbidity in patients with CM-MOH is important to enhance the management of these complex patients, who are at risk of polypharmacy and increased health care utilization.

Housing conditions and non-communicable diseases among older adults in Ireland

Purpose

Housing quality across the life course is an important health determinant. The purpose of this paper is to profile the current housing conditions of older adults in Ireland, and to investigate the association between housing conditions and heating problems and two types of non-communicable diseases: respiratory health problems and bone and joint conditions.

Design/methodology/approach

Data are from the Healthy and Positive Ageing Initiative Age-friendly Cities and Counties Survey, a random-sample, population representative survey of 10,540 adults aged 55 and older collected in 2015–2016. Mixed-effects logistic regression analysis was used to investigate the association between poor housing (leaks, rot and damp) and poor heating (unable to keep the home adequately warm) and the likelihood of having a respiratory health problem or a bone or joint condition. Results are reported as odds ratios with 95% confidence intervals.

Findings

Overall, 10.2 per cent had poor housing and 10.4 per cent had poor heating. Poor housing and poor heating were strongly associated with respiratory health problems and there was a strong association between poor housing and bone and joint conditions. These associations were not explained by health behaviours or socio-demographic characteristics.

Originality/value

Despite a number of publicly funded schemes available to assist in upgrading and maintaining housing, a considerable number of adults aged 55 years and older continue to report problems which are associated with an increased likelihood of respiratory health problem and bone and joint conditions and present a considerable threat to healthy ageing in place.