Hospitalisations With Cryoglobulin-Related Diseases in Spain Over 25 Years

Background

The epidemiology of cryoglobulinemia in Spain has likely changed following the widespread adoption of direct-acting antivirals (DAAs) since 2015 for the treatment of hepatitis C virus (HCV) infection, the principal cause of mixed cryoglobulinemia (MC).

Methods

All hospital admissions of patients with cryoglobulinemic disease at the National Registry of Hospital Discharges were retrospectively examined in Spain from 1997 to 2022. The following primary conditions associated with cryoglobulinemia were considered: chronic viral infections, haematological diseases (HD), and autoimmune diseases (AD).

Results

A total of 16 929 admissions for patients with cryoglobulinemic disease were recorded during the study period. Hospitalisation rates for patients with cryoglobulinemia steadily increased from 1997 to 2015 (from 10.8 to 17.9 admissions per 1 million habitants, APC = +2.1), and decreased from 2018 to 2022 (from 15.7 to 11 admissions per 1 million habitants, APC = −7) (p < 0.001 for all). The drastic changes in HCV prevalence rates determined this shift (26.3% in 1997, 52.7% in 2016 and 27.9% in 2022, p < 0.001). The proportion of patients with cryoglobulinemia associated with hepatitis B virus (HBV), paraproteinemias, non-Hodgkin lymphoma, systemic lupus erythematosus, primary Sjögren syndrome and rheumatoid arthritis steadily increased during the study period as cause of hospitalisation in patients with cryoglobulinemia (from 1997 to 2022, p < 0.001), while human immunodeficiency virus infection remained fairly stable since 2005.

Conclusions

The introduction of DAA as treatment for HCV has resulted in a significant reduction in hospitalisations due to cryoglobulinemia in Spain. As a result, cases due to HBV, hematologic and autoimmune diseases have emerged as conditions of growing importance associated with cryoglobulinemia hospitalisations.