Comorbidity refers to the co-occurrence of two or more diseases in an individual. For example, the diagnosis of heart disease, diabetes, etc. in patients with rheumatic disease.
We know that patients with adult-onset rheumatic disease are at increased risk of comorbidities. Those from deprived socio-economic backgrounds are worse affected. We also know that patients with childhood-onset of rheumatic diseases such as Juvenile Idiopathic Arthritis (JIA), Juvenile Lupus (jSLE) and Juvenile Dermatomyositis (JDM), are at risk of ongoing disease activity with a requirement to take medication and have increased risk of damage with greater disease activity in later life.
During Patients and Public Involvement and Engagement (PPIE) events, young people with juvenile-onset rheumatic disease discussed infections and infertility as being important to them, along with other recognised comorbidities such as heart disease, diabetes.
This study, therefore, wants to investigate whether patients with childhood-onset rheumatic diseases (JIA, iSLE and JDM) may be at risk of increased risk of comorbidities. Also, to explore whether risk may vary according to the age of disease onset, socioeconomic status, disease activity. We are also interested in whether individuals with these diseases are more likely to get infections or be infertile, and to assess the effects of JIA/jSLE/JDM on an individual’s height over time. Data from General Practitioner (GP) records, hospital admissions, English deprivation data, and National statistics within the UK, will be used.
Our findings would better inform patients with JIA/jSLE/JDM, families and carers, and clinicians in their treatment plans and decisions.
This study aims to examine long-term comorbidities of patients with childhood-onset rheumatic diseases: Juvenile Idiopathic Arthritis (JIA), Juvenile Lupus (jSLE) and Juvenile Dermatomyositis (JDM). We also aim to investigate whether patients with these diseases have increased risk of infection/infertility compared to healthy controls, as well as to look at the risk of other comorbidities i.e., heart disease, diabetes. We will use the Clinical Practice Research Datalink (CPRD). CPRD is an electronic health record repository of General practitioner (GP) records, that represent a large longitudinal English primary care population. The CPRD data will be linked to Hospital Episode Statistics (HES) admission data for additional comorbidities, to the English Index of Multiple Deprivation (IMD) to calculate IMD quintiles for each outcome, and to Office for National Statistics (ONS) mortality records.
The objectives are to i) Describe the incidence of comorbidities commonly observed in JIA, jSLE and JDM, ii) Compare the prevalence of comorbidities in individuals with these conditions with those of a matched healthy controls, iii) Identify clusters of comorbidities for each juvenile rheumatic condition, iv) Explore how the prevalence of comorbidities in individuals varies by socioeconomic status in the UK using stratified sex, 10-year age group, and IMD quintiles, v) Analyse trajectories based on inflammatory markers i.e. C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), and Body Mass Index (BMI) after JIA/jSLE/JDM diagnosis using Latent Class analysis, vi) Assess infertility rates in patients who were diagnosed with JIA/jSLE/JDM compared to healthy controls using logistics regression. vii) Compare the rate of hospitalisation and death among JIA, jSLE and JDM patients due to infections using Cox proportional hazards regression.
The public health benefits would be to better inform patients with JIA/jSLE/JDM and their families and carers of the risks of these conditions, and aid clinicians in their treatment decisions.
Incidence and prevalence of JIA, jSLE and JDM in CPRD; prevalence and incidence rates stratified by age, sex, and IMD quintiles if there are sufficient cases in each of JIA, jSLE, and JDM; comparison of incidence and prevalence of 213 comorbidities (211 listed in Head et. al[1], and 2 new emerged from PPIE[2-4] events) in patients with JIA, jSLE, and JDM, and to those with none of these i.e., healthy controls corresponding to the same age, sex, and geographical region; age of onset of comorbidity related to the age of onset of the condition considering sex, race, ethnicity etc.
Results will be age- and sex- standardised using the European Standard Population 2013. Age related subgroups will be compared, including pre-pubertal patients (≤7 years); peri pubertal (8-13 years) and adolescent (14-18 years) of age.
David Hughes - Chief Investigator - University of Liverpool
Sab Siddiq - Corresponding Applicant - University of Liverpool
Clare Pain - Collaborator - Alder Hey Children’s NHS Foundation Trust
Eve Smith - Collaborator - University of Liverpool
Sizheng Zhao - Collaborator - University of Liverpool
David Hughes - Collaborator - University of Liverpool
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation Domains