Abstract
ABSTRACT.The global burden of dengue is increasing against a background of rising global prevalence of chronic noncommunicable diseases (NCDs) and an epidemiological shift of dengue toward older age groups. The contribution of NCDs toward risk for adverse clinical and healthcare utilization outcomes was assessed in a national linked-database study. About 51,433 adult dengue cases between 2014 and 2015 were assessed for outpatient and inpatient claims data in Taiwan’s National Health Insurance Research Database for the 30 days after their dengue diagnosis. A multivariable logistic regression with generalized estimating equations was used to estimate the probability of adverse dengue outcomes in patients with NCDs compared with dengue patients without underlying diseases. Rheumatoid arthritis and related disease were associated with the highest risk of hospitalization after dengue diagnosis (odds ratio: 1.78; 95% CI: 1.37–2.30), followed by stroke, chronic kidney disease (CKD), liver cirrhosis, asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, congestive heart failure, hypertension, and malignancy. Chronic kidney disease and diabetes were associated with higher risks of hospitalization, intensive care unit (ICU) use, and all-cause mortality. After adjusting for socioeconomic status and other variables, the number of coexisting chronic diseases was associated with increasing risk of adverse dengue outcomes. Specific NCDs were associated with longer hospitalizations, ICU admission, and higher healthcare costs. Quantifying the risks of adverse dengue outcomes and health expenditures among dengue patients with preexisting NCDs provides insights for improved clinical management and essential inputs for health economic analyses on the cost-benefit of risk-based routine or catch-up immunization programs.
Highlights
Dengue is a mosquito-borne infectious disease caused by four dengue viruses (DENV) transmitted by Aedes aegypti or Ae. albopictus
Among all and noncommunicable diseases (NCDs) patients, respectively, 30.9% and 44.7% patients were admitted for dengue within 30 days of the Notifiable Disease Dataset of Confirmed Cases (NDDCC) index date (Table 2) 1.7% and 4.0% required intensive care unit (ICU) care and 373 (0.7%) and 326 (2.0%) died within 30 days after the diagnosis
The results indicated that after adjusting for other variables, dose-response patterns were observed among the number of coexisting NCDs, risk of adverse outcomes, and resource utilization (Figure 4) with higher risk for adverse outcomes and more resources used with increasing number of underlying conditions
Summary
Dengue is a mosquito-borne infectious disease caused by four dengue viruses (DENV) transmitted by Aedes aegypti or Ae. albopictus. It emerged as a global public health problem after World War II as a result of ecological disruption, global population growth, urbanization, and travel, and the geographical expansion of the respective vectors.[1] The disease is transmitted in an endemic pattern in at least 128 countries, putting almost four billion people at risk annually.[2] Amidst the global trend of declining communicable diseases,[3] dengue stands out, having doubled in incidence every 10 years in recent decades. The growing burden has resulted in WHO’s listing dengue as one of the 10 threats to global public health in 2019.5
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