title: Burden of anemia in patients with osteoarthritis and rheumatoid arthritis in French secondary care.
abstract: BACKGROUND
  Arthritic disorders can be the cause of hospitalizations, especially among individuals 60 years and older. The objective of this study is to investigate associations between health care resource utilization in arthritis patients with and without concomitant anemia in a secondary care setting in France.
  
  
  METHODS
  This retrospective cohort study utilized data on secondary care activity in 2001 from the Programme de Médicalisation des Systèmes d'Information database. Two cohorts were defined using ICD-10 codes: patients with an arthritis diagnosis with a concomitant diagnosis of anemia; and arthritis patients without anemia. Health care resource utilization for both populations was analyzed separately in public and private hospitals. Study outcomes were compared between the cohorts using standard bivariate and multivariable methods.
  
  
  RESULTS
  There were 300,865 hospitalizations for patients with arthritis only, and 2,744 for those with concomitant anemia. Over 70% of patients with concomitant anemia were in public hospitals, compared with 53.5% of arthritis-only patients. Arthritis patients without anemia were younger than those with concomitant anemia (mean age 66.7 vs 74.6, public hospitals; 67.1 vs 72.2, private hospitals). Patients with concomitant anemia/arthritis only had a mean length of stay of 11.91 (SD 14.07)/8.04 (SD 9.93) days in public hospitals, and 10.68 (SD 10.16)/9.83 (SD 7.76) days in private hospitals. After adjusting for confounders, the mean (95% CI) additional length of stay for arthritis patients with concomitant anemia, compared with those with arthritis only, was 1.56 (1.14-1.98) days in public and 0.69 (0.22-1.16) days in private hospitals. Costs per hospitalization were €;480 (227-734) greater for arthritis patients with anemia in public hospitals, and €;30 (-113-52) less in private hospitals, than for arthritis-only patients.
  
  
  CONCLUSIONS
  Arthritis patients with concomitant anemia have a longer length of stay, undergo more procedures, and have higher hospitalization costs than nonanemic arthritis patients in public hospitals in France. In private hospitals, concomitant anemia was associated with modest increases in length of stay and number of procedures; however, this did not translate into higher costs. Such evidence of anemia-related health care utilization and costs can be considered as a proxy for the clinical significance of anemia.
authors.affiliation: Pfizer Inc, New York, NY, USA. gergana.zlateva@pfizer.com
authors.forename: Gergana
authors.initials: G
authors.lastname: Zlateva
authors.forename: Ruth
authors.initials: R
authors.lastname: Diazaraque
authors.forename: Muriel
authors.initials: M
authors.lastname: Viala-Danten
authors.forename: Liviu
authors.initials: L
authors.lastname: Niculescu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies
references.citation: Ann Rheum Dis. 1996 Mar;55(3):162-8
references.pmid: 8712878
references.citation: J Gerontol A Biol Sci Med Sci. 2006 May;61(5):474-9
references.pmid: 16720744
references.citation: Arch Intern Med. 2003 Jun 23;163(12):1400-4
references.pmid: 12824088
references.citation: Value Health. 2005 Nov-Dec;8(6):629-38
references.pmid: 16283863
references.citation: Am J Med. 2003 Aug 1;115(2):104-10
references.pmid: 12893395
references.citation: Gastroenterology. 2003 Feb;124(2):288-92
references.pmid: 12557133
references.citation: J Rheumatol. 2004 Jul;31(7):1297-304
references.pmid: 15229947
references.citation: J Manag Care Pharm. 2005 Sep;11(7):565-74
references.pmid: 16137214
references.citation: Am J Health Syst Pharm. 2007 Aug 15;64(16 Suppl 11):S3-10
references.pmid: 17687068
references.citation: Rheumatol Int. 2004 Jan;24(1):14-9
references.pmid: 12720045
references.citation: BMC Geriatr. 2008 Jan 14;8:1
references.pmid: 18194534
references.citation: World Health Organ Tech Rep Ser. 2003;919:i-x, 1-218, back cover
references.pmid: 14679827
references.citation: Arthritis Rheum. 1998 May;41(5):778-99
references.pmid: 9588729
references.citation: Rheumatology (Oxford). 2000 Jan;39(1):28-33
references.pmid: 10662870
references.citation: Am J Med. 2004 Apr 5;116 Suppl 7A:50S-57S
references.pmid: 15050886
references.citation: N Engl J Med. 2002 Dec 26;347(26):2104-10
references.pmid: 12501222
references.citation: N Engl J Med. 1993 Sep 23;329(13):931-5
references.pmid: 8361508
references.citation: Curr Opin Rheumatol. 2002 Sep;14(5):573-7
references.pmid: 12192258
references.citation: J Cardiovasc Pharmacol. 2006;47 Suppl 1:S72-5
references.pmid: 16785834
references.citation: N Engl J Med. 2005 Mar 10;352(10):1011-23
references.pmid: 15758012
references.citation: Pharmacoeconomics. 2004;22(2 Suppl 1):1-12
references.pmid: 15157000
references.citation: BMJ. 1994 Nov 19;309(6965):1337-8
references.pmid: 7866082
references.citation: J Am Geriatr Soc. 2004 May;52(5):719-24
references.pmid: 15086651
references.citation: World Health Organ Tech Rep Ser. 1968;405:5-37
references.pmid: 4975372
references.citation: J Gerontol A Biol Sci Med Sci. 2005 Jun;60(6):729-35
references.pmid: 15983175
references.citation: Arthritis Rheum. 1988 Oct;31(10):1318-21
references.pmid: 3178910
references.citation: Clin Rheumatol. 1999;18(4):293-8
references.pmid: 10468168
references.citation: Rheumatology (Oxford). 2005 Dec;44(12):1531-7
references.pmid: 16091394
references.citation: Arthritis Rheum. 2008 Jan;58(1):15-25
references.pmid: 18163481
references.citation: Semin Arthritis Rheum. 1990 Feb;19(4):209-23
references.pmid: 2181669
references.citation: Br Heart J. 1993 Oct;70(4):357-62
references.pmid: 8217445
references.citation: J Rheumatol. 1997 Apr;24(4):719-25
references.pmid: 9101508
references.citation: J Am Geriatr Soc. 2005 Dec;53(12):2106-11
references.pmid: 16398894
references.citation: Br J Haematol. 1987 Aug;66(4):559-64
references.pmid: 3663512