Jenkins-Jones, S., Parviainen, L., Porter, J. et al. (6 more authors) (2018) Poor compliance and increased mortality, depression and healthcare costs in patients with congenital adrenal hyperplasia. European Journal of Endocrinology, 178 (4). pp. 309-320. ISSN 0804-4643
Abstract
Objectives To evaluate risks of depression and all-cause mortality, healthcare utilisation costs, and treatment adherence in congenital adrenal hyperplasia (CAH) in the UK. Design and Methods A retrospective, matched-cohort study using UK primary-care data from the Clinical Practice Research Datalink linked to hospital and death-certification data. Patients diagnosed with CAH and having ≥1 corticosteroid prescription were matched 1:10 to reference subjects. Risk of death and lifetime prevalence of depression were compared using Cox regression models. Direct financial costs were estimated for healthcare contacts. Treatment adherence was measured by medical possession ratio (MPR). Results 605 patients with CAH were identified; 562 were matched. 270 CAH patients (2,700 controls) were linkable to death-certificate data, with adjusted hazard ratio for all-cause mortality 5.17 (95%CI 2.81 to 9.50). Mean (SD) age at death in CAH patients was 54.8 (23.9) versus 72.8 (18.0) years in control patients. The prevalence ratio of depression in CAH versus control patients was 1.28 (95%CI 1.13 to 1.45). Mean (SD) annual healthcare costs were higher in CAH than controls: at age 0-6 years, £7,038 (£14,846) versus £2,879 (£13,972, p<0.001); 7-17 years, £3,766 (£7,494) versus £1,232 (£2,451, p<0.001); 18-40 years, £1,539 (£872) versus £1,344 (£1,620, p=0.007); and ≥41 years, £4,204 (£4,863) versus £1,651 (£2,303, p<0.001). Treatment adherence was lowest in adults, with 141 (36%) of 396 eligible patients having an MPR <80%. Conclusions This first analysis of CAH in routine UK healthcare suggests that patients with CAH have increased mortality, depression, and healthcare utilisation, and low treatment adherence.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 BioScientifica. This is an author produced version of a paper subsequently published in European Journal of Endocrinology. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Division of Genomic Medicine (Sheffield) > Department of Oncology and Metabolism (Sheffield) The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 06 Feb 2018 10:37 |
Last Modified: | 15 Dec 2020 12:31 |
Status: | Published |
Publisher: | BioScientifica |
Refereed: | Yes |
Identification Number: | 10.1530/EJE-17-0895 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:127080 |