Incident Comorbidity, Resource Use, and All-Cause Mortality Associated with Prurigo Nodularis: A United Kingdom Retrospective Database Analysis

Abstract

We described comorbidity, resource utilization, and mortality for patients with prurigo nodularis (PN) using data from the Clinical Practice Research Datalink. Patients with incident PN (2008-2018) were selected and matched to controls. Of 2,416 patients with PN, 2,409 (99.7%) were matched to controls. Prevalence of atopic dermatitis (relative risk [RR]= 2.571; 95% confidence interval [CI]= 2.356-2.806), depression (RR= 1.705; 95% CI= 1.566-1.856), anxiety (RR= 1.540; 95% CI= 1.407-1.686), coronary heart disease (RR= 1.575; 95% CI= 1.388-1.787), chronic kidney disease (RR= 1.529; 95% CI= 1.329-1.759), and type 2 diabetes mellitus (RR= 1.836; 95% CI= 1.597-2.111) was significantly higher for patients with PN. Subsequent risk of atopic dermatitis (hazard ratio= 6.58; 95% CI= 5.17- 8.37), depression (hazard ratio= 1.61; 95% CI= 1.30-1.99), and coronary heart disease (hazard ratio= 1.37; 95% CI= 1.09-1.74) were significantly increased. Resource utilization was increased in all settings: incidence rate ratio= 1.48 (95% CI= 1.47-1.49) for primary care, incident rate ratio= 1.80 (95% CI= 1.75-1.85) for inpatients, incident rate ratio= 2.15 (95% CI= 2.13-2.18) for outpatients, and incidence rate ratio= 1.32 (95% CI= 1.27-1.36) for accident and emergency. Respective cost ratios were 1.78 (95% CI= 1.67-1.90), 1.52 (95% CI= 1.20-1.94), 2.34 (95% CI= 2.13-2.58), and 1.55 (95% CI= 1.33-1.80). Total primary and secondary healthcare costs were £2,531 versus £1,333, a cost ratio of 1.62 (95% CI= 1.36-1.94). The adjusted hazard ratio for mortality was 1.37 (95% CI= 1.14-1.66). Patients with PN had significantly increased rates of comorbidity, healthcare resources utilization, and mortality compared with matched controls.