title: Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care.
abstract: The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case-control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P < 0.001), and greater disability (1.04 vs 0.35; P < 0.001), anxiety (43.9% vs 13.3%; P < 0.001), depression (27% vs 5.8%; P < 0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus, and number of cardiovascular events (13.1% vs 4.8%; P = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were &OV0556;3751 per year in patients with CWP vs &OV0556;1397 in controls (P < 0.001). In conclusion, the average patient with CWP has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations.
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Enma Marianela
authors.initials: EM
authors.lastname: Morales-Espinoza
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Belchin
authors.initials: B
authors.lastname: Kostov
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Daniel Cararach
authors.initials: DC
authors.lastname: Salami
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Zoe Herreras
authors.initials: ZH
authors.lastname: Perez
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Anna Pereira
authors.initials: AP
authors.lastname: Rosalen
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Jacinto Ortiz
authors.initials: JO
authors.lastname: Molina
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Gonzalez-de Paz
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Josep Miquel Sotoca
authors.initials: JMS
authors.lastname: Momblona
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Jaume Benavent
authors.initials: JB
authors.lastname: Àreu
authors.affiliation: Josep Font Laboratory of Autoimmune Diseases, CELLEX-IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Brito-Zerón
authors.affiliation: Josep Font Laboratory of Autoimmune Diseases, CELLEX-IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramos-Casals
authors.affiliation: Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Sisó-Almirall
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D016022:Case-Control Studies; D059350:Chronic Pain / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics*; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires