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Abstract
Background There is a dearth of epidemiological studies in the US and worldwide on Adult Onset Still's Disease (AOSD). Currently, there is no consensus on its incidence and prevalence in different populations. Most studies report a majority of patients below the age of 35.[1]
Objectives To describe the demographics, complications and mortality of hospitalized patients with AOSD in United States.
Methods All adult (>18 years) hospitalized patients in 2013 from a nationwide inpatient sample (NIS) database were captured. AOSD patients were identified using the ICD-9 code 714.2 that was in use in 2013. Patients also coded for Rheumatoid Arthritis, Lupus, Myositis, Polymyalgia Rheumatica, Ankylosing Spondylosis and Psoriatic Arthritis were excluded. This was done in order to truly capture patients with strictly AOSD. NIS is the largest all- payer inpatient care database in the United States with approximately 8 million hospitalizations each year. Discharge weights were used to enable nationwide estimates. Descriptive statistics were represented as means/medians for continuous and as frequencies and percentages for categorical variables.
Results In 2013, 1410 US patients were coded with the ICD-9 code 714.2 and, after excluding concomitant rheumatic disease diagnoses as per protocol, 1265 AOSD patients were analyzed. AOSD patients had a mean age of 53.8 (SD - 18.1) years and a median age of 54 years. 70.4% were females. The racial/ethnic distribution showed that 61.6% white, 13.9% African American and 17.3% Hispanic patients were affected. 56.9% were hospitalized in urban teaching hospitals. The Mid-Atlantic census division had the highest number of patients – 240 (Figure). 35 (2.8%) of patients developed Macrophage Activating Syndrome (MAS). 30 (2.4%) patients had other severe complications of AOSD like disseminated intravascular coagulation (DIC) and thrombotic thrombocytopenic purpura (TTP). Median length of stay was 4 days and median hospital charges were $31,400 (Table). There were 35 inpatient deaths (mortality 2.8%): 71.4% of deaths were in females, 50% in Asians, and 71.4% were in patients in the 54- 67 age group.
Conclusions In hospitalized American AOSD patients, the average age was higher than previously thought. This may indicate an aging population with a higher number of comorbidities that justify hospitalization. Mortality increased with age and was higher among women and Asians. To our knowledge, this is the largest epidemiological study of AOSD today in the USA.
References
Sakata N, Shimizu S, Hirano F, Fushimi K. Epidemiological study of adult-onset Still's disease using a Japanese administrative database. Rheumatol Int 2016;36(10):1399–405 doi: 10.1007/s00296–016–3546–8.
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Disclosure of Interest None declared