Background: Systemic lupus erythematosus (SLE) is a costly and crippling autoimmune disease.However, a nationwide follow-up study was unavailable to identify the nature and scale of healthcare utilization prior to SLE diagnosis among those affected individuals until now, which may forbid performing an early aggressive management for SLE patients.
Aims: To examine the ambulatory care utilization over the past 8 years before SLE diagnosis for those with newly diagnosed SLE compared with non-SLE subjects.
Methods: We conducted a retrospective comparison study to recruit 337 SLE patients diagnosed between 2004 and 2010 aged 18 years or older, together with 1348 subjects matched non-SLE enrollees as a comparison cohort from Taiwan National Health Insurance Research Database. The patterns of ambulatory care utilization including visits and cots during the previous consecutive 8 years before SLE diagnosis for all subjects were calculated. Generalized Estimating Equation model were used to assess the linear trend of ambulatory care utilization during the study period.
Results: Across the observed period, SLE patients incurred more ambulatory care utilization than the general population, especially peaking within two years prior to SLE in the consumption of health care services. The average annual ambulatory care visits in case groups increased from 8.31 to 25.23 times during the study period, representing a significant linear trend (β=0.20 ; p <0.001)).As for the costs, it rose approximately five times from US$ 232.05 to US$ 1133.91, with a significantly linearly rising trend (β=0.06; p <0.001). The three most frequent principal diagnoses at ambulatory visits were respiratory system disease, followed by diseases of musculoskeletal system and connective tissue, and digestive system diseases.
Conclusions: Progressive increases in ambulatory care utilization were demonstrated prior to SLE onset, particularly two years preceding SLE. An effective referral system and interventions aimed at preventing SLE are warranted.
