Real-World Investigation of Eosinophilic-Associated Disease Overlap (REVEAL): Analysis of a US Claims Database

Abstract

Purpose: The epidemiology of eosinophil-associated diseases (EADs) is not yet fully understood. While some studies have been conducted on stand-alone eosinophilic diseases, there is scarce evidence on the degree of overlap among rarer conditions.

Methods: The retrospective Real-world inVestigation of Eosinophilic-Associated disease overLap (REVEAL) study used data from the Optum^® Clinformatics^® insurance claims database to describe and characterize disease overlap among 11 EADs: allergic bronchopulmonary aspergillosis, atopic dermatitis, chronic rhinosinusitis with nasal polyps, eosinophilic gastritis/gastroenteritis, eosinophilic granulomatosis with polyangiitis, eosinophilic esophagitis, bullous pemphigoid, chronic obstructive pulmonary disorder, chronic spontaneous urticaria, and non-cystic fibrosis bronchiectasis. Patient records with EADs of interest were identified between January 1, 2015, and June 30, 2018.

Results: Overall, 1,326,645 patients were included; 74.4% had 1 EAD, 20.5% had ≥ 2 EADs, and 5.1% had ≥ 3 EADs. Higher rates of disease overlap were associated with older age. Higher blood eosinophil counts were also observed in patients with a greater number of overlapping conditions, suggesting a common role for eosinophilic inflammation in the pathogenesis of multiple diseases. Furthermore, greater disease overlap was associated with higher disease severity in most cohorts.

Conclusions: Results from this study have implications for quantifying unmet needs and can be used to inform treatment guidelines and raise the awareness of eosinophilic inflammation and EAD overlap among healthcare professionals from a range of disease specialties.

Keywords: Inflammation; disease attributes; eosinophilia; eosinophils; epidemiology; multimorbidity.

Fig. 1. Patient population identification.

EAD, eosinophilic-associated disease.

Fig. 2. Frequency of disease overlap with any 2 conditions among patients with (A) historically considered EADs or (B) EADs with emerging eosinophil involvement.

ABPA, allergic bronchopulmonary aspergillosis; BP, bullous pemphigoid; EG/EGE, eosinophilic gastritis/gastroenteritis; EoE, eosinophilic esophagitis; EGPA, eosinophilic granulomatosis with polyangiitis; CSU, chronic spontaneous urticaria; AD, atopic dermatitis; NCFB, non-cystic fibrosis bronchiectasis; CRSwNP, chronic rhinosinusitis with nasal polyps; COPD, chronic obstructive pulmonary disease; EAD, eosinophilic-associated disease.

Fig. 3. Rates of EAD overlap by disease severity.^*

ABPA, allergic bronchopulmonary aspergillosis; BP, bullous pemphigoid; EG/EGE, eosinophilic gastritis/gastroenteritis; EoE, eosinophilic esophagitis; EGPA, eosinophilic granulomatosis with polyangiitis; CSU, chronic spontaneous urticaria; AD, atopic dermatitis; NCFB, non-cystic fibrosis bronchiectasis; CRSwNP, chronic rhinosinusitis with nasal polyps; COPD, chronic obstructive pulmonary disease; EAD, eosinophilic-associated disease. ^*See Supplementary Table S3 for definitions of disease severity.

Fig. 4. Percentages of patients with high blood eosinophil counts (≥ 300 cells/µL) by degree of EAD overlap.^*

ABPA, allergic bronchopulmonary aspergillosis; EAD, eosinophilic-associated disease; AD, atopic dermatitis; CRSwNP, chronic rhinosinusitis with nasal polyps; EG/EGE, eosinophilic gastritis/gastroenteritis; EGPA, eosinophilic granulomatosis with polyangiitis; EoE, eosinophilic esophagitis; BP, bullous pemphigoid; COPD, chronic obstructive pulmonary disease; CSU, chronic spontaneous urticaria; NCFB, non-cystic fibrosis bronchiectasis. ^*The subgroups are not mutually exclusive (i.e., the same patients may be represented in ≥1 two-condition group), resulting in percentages exceeding 100%. The bars in each graph represent the proportion of patients with high blood eosinophil counts in each subgroup. The percentage of cohort refers to the proportion of patients in each subgroup that comprise the total EAD cohort.

Fig. 5. Percentages of patients with high blood eosinophil counts (≥ 300 cells/µL) in each EAD cohort by overlapping EAD.

ABPA, allergic bronchopulmonary aspergillosis; EAD, eosinophilic-associated disease; AD, atopic dermatitis; CRSwNP, chronic rhinosinusitis with nasal polyps; EG/EGE, eosinophilic gastritis/gastroenteritis; EGPA, eosinophilic granulomatosis with polyangiitis; EoE, eosinophilic esophagitis; BP, bullous pemphigoid; COPD, chronic obstructive pulmonary disease; CSU, chronic spontaneous urticaria; NCFB, non-cystic fibrosis bronchiectasis.