Chang JC, et al. - This study compared youth with systemic lupus erythematosus (SLE) and controls for characterizing health care utilization in the year preceding SLE diagnosis. Throughout the year preceding SLE diagnosis, a high health care utilization was reported for youth with SLE. For improving care for youth with new-onset SLE, examining variable diagnostic trajectories of youth presenting for acute care preceding SLE diagnosis, and increased attention to psychiatric morbidity may be helpful.

Methods

• Using Clinformatics DataMart (OptumInsight, Eden Prairie, MN) de-identified administrative data from 2000 to 2013, researchers identified 682 youth ages 10-24 years with new-onset SLE (≥3 International Classification of Diseases, Ninth Revision (ICD-9) codes for SLE 710.0, each >30 days apart), and 1,364 age and sex-matched healthy controls.
• They compared the incidence of ambulatory, emergency, and inpatient visits 12 months before SLE diagnosis, and frequency of primary diagnoses.
• They also assessed subject characteristics related to utilization preceding SLE diagnosis.

Results

• Findings demonstrated that across ambulatory (incidence rate ratio (IRR) 2.48, p<0.001), emergency (IRR 3.42, p<0.001) and inpatient settings (IRR 3.02, p<0.001), youth with SLE had significantly more visits in the year preceding diagnosis than controls.
• Venous thromboembolism (313, interquartile range (IQR) 18-356), thrombocytopenia (278, IQR 39-354), chest pain (73, IQR 29.5-168), fever (52, IQR 17-166), and acute kidney failure (14, IQR 5-168) were reported as the most frequent acute care diagnoses and median days to SLE diagnosis.
• Notably, across all settings, a strong association was evident between having a psychiatric diagnosis prior to SLE diagnosis and increased utilization.