Healthcare Utilization and Comorbidity in Chronic Lymphocytic Leukemia

Abstract

Purpose: Age-related comorbidity is highly prevalent in chronic lymphocytic leukemia (CLL). The purpose of this study was to provide information on current patterns of healthcare utilization in CLL.

Patients and methods: We used data from Danish nation-wide registers to study healthcare utilization the year before and the year after CLL diagnosis and in relation to first-line treatment. Patients diagnosed with CLL between 1997 and 2018 were included and stratified on number of comorbidities, presence of specific comorbidities, and fitness status, respectively. Healthcare utilization was studied in terms of hospital admissions, in-hospital bed days, out-patient visits, emergency room visits, and prescription drugs. Odds ratios with 95% confidence intervals were calculated using multivariable logistic regression analyses adjusting for age, sex, and calendar year.

Results: The study comprised 9170 patients with CLL with a median age of 71 years, of whom 35% had ≥1 comorbidity. Healthcare utilization increased markedly upon CLL diagnosis both in patients with and without comorbidities. During the year after CLL diagnosis, 39% were hospitalized, 16% visited an emergency room, 88% visited an out-patient clinic, and 93% received prescription drugs. Both individual comorbidities and the total number of comorbidities were associated with increased healthcare utilization of all types, except for contacts to hematological departments.

Conclusion: Our results suggest that CLL diagnosis may unveil incipient diseases and aggravate comorbidities and thereby have considerably wider health implications than those directly related to CLL. These findings may be used by clinicians and decisions makers to guide planning of multidisciplinary care for cancer patients.

Keywords: chronic lymphocytic leukemia; epidemiology; hematology; real-world data.

Figure 1

Inverted Lorenz curves for in-hospital bed days. In-hospital bed days for patients with CLL without comorbidities (A), with 1 comorbidity (B), or with 2 or more comorbidities (C), the year before and the year after CLL diagnosis. Inverted Lorenz curves are illustrating cumulative percentage frequency distributions of in-hospital bed days. The x axis shows percentage of bed days and the y axis the cumulative percentage of patients that contributed to the bed days. The reference line illustrates the percentage of the patients who accounted for 90% of the total number of bed days.

Figure 2

Forest plot of odds ratios for healthcare utilization. Healthcare utilization in terms of ≥5 in hospital bed days, emergency room visits, hospitalizations, ≥5 out-patients clinic visits, and ≥6 prescription drugs during the year after CLL. ORs is for CLL patients with co-existing diabetes (DM), chronic pulmonary disease (CPD), congestive heart failure or MI (CHD/MI), or cerebrovascular disease (CeD) compared with CLL patients without the same specific co-existing condition. ORs are adjusted for age, sex, calendar year, and multimorbidity. ORs are presented on a base-10 logarithmic scale.