Abstract
To investigate the patterns of healthcare use (HCU) at the last year of life in persons with osteoarthritis (OA). Using linked registers, we identified persons aged≥ 65 years who died during 2003-2014 and were resided in the Skåne region during 5-year prior to death. Among these, we randomly matched decedents with a principal OA diagnosis prior to the last year of life (OA cohort, n=17,993) with up to 4 comparators without OA by sex, age at death, and year of death (n=59,945). We measured monthly HCU for each decedent during last year of life and applied two-part regression models to estimate HCU attributable to OA. Group-based trajectory modelling (GBTM) was used to detect distinct trajectories of HCU within the OA cohort. During last 12-month of life, each person with OA had, on average, 2.5 (95% CI 2.2, 2.7) excess healthcare consultations and 1.8 (95% CI 1.3, 2.2) more inpatient days than those without OA. While both cohorts observed increasing trends in HCU towards death, excess healthcare consultations attributable to OA declined and inpatient days increased as death approached. For both healthcare consultations and inpatient days, GBTM identified four distinct trajectory classes. While underlying cause of death and age were the most important predictors of class membership, the overall predictive accuracy was poor. OA was associated with excess HCU especially hospital-based care during the last year of life. However, there seem to be distinct trajectory classes within the OA patient population.
Highlights
Osteoarthritis (OA) is a chronic joint disease associated with pain, disability, and reduced quality of life1e3
Considering the rises in the prevalence of OA and other chronic conditions with age, an ageing population implies that the number of OA patients with multimorbidity will rise which can lead to higher healthcare use (HCU) toward the end-of-life
The first part was a logistic regression model to estimate the probability of any HCU during a month, and second part was a generalized linear model (GLM) with gamma distribution and log link for months with non-zero HCU
Summary
Osteoarthritis (OA) is a chronic joint disease associated with pain, disability, and reduced quality of life1e3. OA patients has been reported to incur greater healthcare use (HCU) and expenditure compared with age- and sex-matched counterparts without OA5e7. This greater HCU might partially be attributable to multimorbidity given that OA is among the diseases with the highest rate of multimorbidity with around 2 out of 3 OA patients having one or more other co-existing conditions[8]. Considering the rises in the prevalence of OA and other chronic conditions with age, an ageing population implies that the number of OA patients with multimorbidity will rise which can lead to higher HCU toward the end-of-life. While a large number of studies investigated the end-of-life patterns of HCU, especially in cancer patients, little is known about such patterns among OA patients
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