Avoidable Hospitalizations in Persons With Rheumatoid Arthritis: A Population-Based Study Using Administrative Data.

Abstract

Objective: We estimated incidence rates of avoidable hospitalizations by persons with rheumatoid arthritis (RA) relative to the general population.

Methods: We identified individuals meeting a validated case definition for RA based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CA codes in years 2002 to 2023. Four general population controls were matched to each RA case by age and sex. We identified hospitalizations for ambulatory care sensitive conditions (ACSCs), including grand mal seizures, chronic lower respiratory diseases, asthma, diabetes, heart failure and pulmonary edema, hypertension, and angina, from 2007 to 2023 by established diagnostic codes. Incidence rate ratios (IRRs) three and five years from the date of diagnosis were calculated using a multivariable regression model adjusting for age, sex, and location of residence. A Cox proportional hazards model was used to identify predictors of avoidable hospitalizations among patients with RA.

Results: Persons with RA (n = 83,811) had 1.12 times the risk of hospitalization for heart failure and pulmonary edema compared to those without RA (n = 190,304) (IRR 1.12, 95% confidence interval [CI] 1.01-1.25). Significant predictors of ACSC hospitalizations for RA cases were increasing age, prolonged exposure to glucocorticoids, and having comorbid conditions, especially if the comorbid condition was an ACSC (hazard ratio 10.1, 95% CI 7.8-13.0).

Conclusion: Persons with RA are at a higher risk of potentially avoidable hospitalizations three and five years after diagnosis compared to those without RA. Improved ambulatory care access and quality, inclusive of primary care and subspecialty care, is proposed to prevent unnecessary hospitalizations and reduce burden on the acute care system.