Comprehensive assessment of multimorbidity burden in a population-based cohort of patients with rheumatoid arthritis

Abstract

Objective: To comprehensively assess multimorbidity burden in patients with rheumatoid arthritis (RA) in order to unify the multimorbidity definition for RA research and clinical practice.

Methods: In this population-based study, residents of eight Minnesota counties with prevalent RA on 1 January 2015 were identified. Age, sex and county-matched non-RA comparators were selected from the same population. Diagnostic codes were retrieved for 5 years before 1 January 2015. Using two codes ≥30 days apart, 44 previously defined morbidities and 78 non-overlapping chronic disease categories based on Clinical Classification Software were defined. Prevalence of each morbidity in the RA versus non-RA cohorts was compared using false discovery rate to adjust for multiple comparisons. Morbidities more common in RA than non-RA and those with prevalence ≥5% were retained.

Results: 1643 patients with RA and 1643 non-RA subjects (72% women; mean age 63.1 years) were studied. Using the 44 morbidities, multimorbidity (defined as 2+ morbidities) was present in 1411 (86%) of RA and 1164 (71%) of non-RA subjects (p<0.001) with 5+ morbidities present in 907 (55%) of RA and 619 (38%) of non-RA (p<0.001). Patients with RA had significantly higher prevalence of 24 of the 44 morbidities compared with non-RA, especially interstitial lung disease, fibromyalgia, osteoarthritis and osteoporosis. Among the additional 78 categories, 7 were significantly higher in RA than non-RA, including organic sleep disorders, vitamin D deficiency and foot ulcers.

Conclusion: Patients with RA have a higher prevalence of multimorbidity compared with non-RA subjects. These results confirm the list of 44 morbidities and add several other morbidities of interest in RA.

Keywords: cardiovascular diseases; epidemiology; rheumatoid arthritis.

Figure 1

The percentage of patients with and without rheumatoid arthritis (RA) who had 2–4 or 5+ morbidities in the primary list of 44 morbidities by age group.

Figure 2

The proportion of morbidities identified by number of months prior to 1 January 2015 in the combined rheumatoid arthritis (RA) and non-RA cohorts. Coloured lines show each of the 44 primary and 11 additional secondary morbidities; the highest coloured line depicts diabetes, which has a shorter median than the others. The black line shows the overall average, demonstrating that 18 months are needed to identify 50% of these chronic morbidities.