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. 2018 Apr;70(4):652-658.
doi: 10.1002/acr.23328. Epub 2018 Feb 18.

Trends in Hospitalizations for Serious Infections in Patients With Rheumatoid Arthritis in the US Between 1993 and 2013

Sadao Jinno  1 , Na Lu  1 , S Reza Jafarzadeh  1 , Maureen Dubreuil  2
Affiliations

Trends in Hospitalizations for Serious Infections in Patients With Rheumatoid Arthritis in the US Between 1993 and 2013

Sadao Jinno et al. Arthritis Care Res (Hoboken). 2018 Apr.

Abstract

Objective: The epidemiology of hospitalizations with infections among patients with rheumatoid arthritis (RA) is unknown, despite an increase in RA treatments that confer a risk of infection.

Methods: We examined National Inpatient Sample data from 1993-2013. We identified hospitalizations among adults with RA, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes (714.xx) in any secondary diagnosis field. We evaluated 5 infections as the primary diagnosis: pneumonia, sepsis, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), and opportunistic infections (OIs). The primary outcome was the proportion of hospitalizations for each infection among all hospitalizations with a secondary diagnosis of RA.

Results: There were 792,921 hospitalizations for infection with a secondary diagnosis of RA, with the rates increasing from 90 to 206 per 100,000 persons from 1993-2013. The proportion of hospitalizations decreased for pneumonia (from 5.4% to 4.6%), UTI (from 0.4% to 0.38%), and OIs (from 0.44% to 0.26%). The proportion of hospitalizations for SSTIs increased slightly (from 2.3% to 2.5%), while hospitalizations for sepsis more than tripled (from 1.9% to 6.4%).

Conclusion: Between 1993 and 2013, the proportion of hospitalizations for infections among RA patients appeared to decline for pneumonia and OIs, with a slight decrease in UTI, a slight increase in SSTIs, and a substantial increase in hospitalizations with sepsis. Our results are consistent with previous reports that the sensitivity of sepsis coding has increased over time.

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Figures

Figure 1
Figure 1
Proportion of all US RA hospitalizations for infection, stratified by infection type UTI; urinary tract infection, SSTI; skin and soft tissue infections, OI; opportunistic infections
Figure 2
Figure 2
Incidence of hospitalized infection of pneumonia, sepsis, UTI, and SSTI among RA (solid lines) and non-RA (dashed lines), from 1993–2013 National Inpatient Sample UTI; urinary tract infection, SSTI; skin and soft tissue infections
See this image and copyright information in PMC

References

    1. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study. Arthritis Rheum. 2002;46:2287–93. - PubMed
    1. Yazici Y, Shi N, John A. Utilization of biologic agents in rheumatoid arthritis in the united states: Analysis of prescribing patterns in 16,752 newly diagnosed patients and patients new to biologic therapy. Bull NYU Hosp Jt Dis. 2008;66:77–85. - PubMed
    1. Ni Mhuircheartaigh OM, Matteson EL, Green AB, Crowson CS. Trends in serious infections in rheumatoid arthritis. J Rheumatol. 2013;40:611–6. - PMC - PubMed
    1. Walkey AJ, Lagu T, Lindenauer PK. Trends in sepsis and infection sources in the united states. A population-based study. Ann Am Thorac Soc. 2015;12:216–20. - PMC - PubMed
    1. Jafarzadeh SR, Thomas BS, Marschall J, Fraser VJ, Gill J, Warren DK. Quantifying the improvement in sepsis diagnosis, documentation, and coding: The marginal causal effect of year of hospitalization on sepsis diagnosis. Ann Epidemiol. 2016;26:66–70. - PMC - PubMed

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