Abstract
BackgroundInterstitial lung diseases (ILDs) are associated with a high burden of disease. However, data on the prognostic impact of comorbidities and comorbidity-related pharmaceutical treatments in patients with various ILDs remain sparse.MethodsUsing longitudinal claims data from a German Statutory Health Insurance Fund, we assessed comorbidity in ILD subtypes and associated drug treatments. Baseline comorbidity was assessed via the Elixhauser Comorbidity Index that was amended by ILD-relevant conditions. Drug treatment was assessed on the substance level using the ATC-codes of drugs prescribed at the time of ILD diagnosis. Subsequently, the comorbid conditions (main analysis) and pharmaceutical substances (secondary analysis) with a meaningful association to survival were identified for the complete ILD cohort and within the subtype strata. For this, we applied multivariate Cox models using a LASSO selection process and visualized the findings within comorbidomes.ResultsIn the 36,821 patients with ILDs, chronic obstructive pulmonary disease (COPD), arterial hypertension, and ischaemic heart disease (IHD) were the most prevalent comorbidities. The majority of patients with cardiovascular diseases received pharmaceutical treatment, while, in other relevant comorbidities, treatment quotas were low (COPD 46%, gastro-oesophageal reflux disease 65%). Comorbidities had a clinically meaningful detrimental effect on survival that tended to be more pronounced in the case of untreated conditions (e.g. hazard ratios for treated IHD 0.97 vs. 1.33 for untreated IHD). Moreover, comorbidity impact varied substantially between distinct subtypes.ConclusionsOur analyses suggest that comorbid conditions and their treatment profile significantly affect mortality in various ILDs. Therefore, comprehensive comorbidity assessment and management remains important in any ILD.
Highlights
Interstitial lung diseases (ILDs) are associated with a high burden of disease
The transferability of corresponding findings to routine care settings remains slightly uncertain [4]. This has been highlighted in other diseases such as chronic obstructive pulmonary disease (COPD), in which comorbidities play a significant role in management decisions and clinical outcome [5]
We considered the non-Elixhauser Index (EI) conditions gastro-oesophageal reflux disease (GERD), obstructive sleep apnoea syndrome (OSAS), ischaemic heart disease (IHD), and thromboembolism based on previous evidence on their ILD relevance [15, 16, 28]
Summary
Interstitial lung diseases (ILDs) are associated with a high burden of disease. data on the prognostic impact of comorbidities and comorbidity-related pharmaceutical treatments in patients with various ILDs remain sparse. Assuming that a similar interaction between comorbidity and outcomes in various ILD subtypes exists, more research is currently being conducted These investigations are urgently recommended because the relationships between an index disease (here: ILD) and comorbidities include conditions that occur incidentally (e.g. arterial hypertension) as well as potential risk factors (e.g. gastro-oesophageal reflux) or complications respectively sequelae of the index disease (e.g. pulmonary hypertension). These different interaction modes introduce a high level of complexity [6]
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