Avoidable Acute Care Use by Persons with Rheumatoid Arthritis: A Population-Based Study

Date
2025-03-07
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Abstract

Rheumatoid Arthritis (RA) is Canada’s most common chronic inflammatory joint disease, affecting 1.2% of Canadians 16 years and older, and is more prevalent among females. People with RA have an increased risk of mortality compared to the general population due to comorbidities such as cardiovascular disease, depression, and osteoporosis. The presence of these comorbidities can lead to increased healthcare utilization, including hospitalizations. Most healthcare interactions for treating and monitoring RA occur in the outpatient setting, usually with a family physician or a rheumatologist. Ambulatory Care Sensitive Conditions (ACSCs) were thus derived as a list of conditions where appropriate ambulatory care would prevent or reduce the need for hospital admission. The objective of this thesis is to estimate incidence rates of avoidable acute care use by persons with RA relative to the general population. The RA cohort was established by identifying individuals meeting a validated case definition for RA based on ICD-9-CM and ICD-10-CA codes in years 2002-2023. Four general population controls were matched to each RA case by age, sex, and date of diagnosis. Acute care use for ACSCs including grand mal seizures, chronic lower respiratory diseases, asthma, diabetes, heart failure and pulmonary edema, hypertension, and angina from 2007-2023 were identified by established diagnostic codes. Incidence rate ratios 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 RA patients. RA cases had a 14% higher risk of hospitalization and a 6% higher rate of ED visits for any ACSC compared those without RA. Significant predictors of ACSC hospitalizations for RA cases were increasing age, prolonged exposure to corticosteroids, being from a rural location, and having comorbid conditions, especially if the comorbid condition is an ACSC. Persons with RA are at a higher risk of potentially avoidable acute care use compared to those without RA. Improved ambulatory care access and quality, inclusive of primary care and contributing role of subspecialty care, is proposed to prevent unnecessary hospitalizations and reduce burden on the acute care system.

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Keywords
Rheumatoid Arthritis, Acute Care Use, Hospitalizations, Emergency Department Visits, Ambulatory Care Sensitive Conditions, Health Services Research
Citation
Contreras, D. (2025). Avoidable acute care use by persons with rheumatoid arthritis: a population-based study (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.