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Objectives: Post-COVID conditions (PCC) are increasingly reported in people who had COVID. Certain racial or socioeconomic groups may be at greater risk for PCC and less likely to seek care. We examined the uptake of the new ICD-10-CM diagnosis code for PCC in routine clinical practice in the United States and how it varied by race and payer group. Method(s): Using the Optum de-identified Electronic Health Record (EHR) dataset, we identified patients with an ICD-10-CM code for PCC (U09.9) between October 1, 2021, through March 31, 2022, with 6 months of prior EHR activity. The earliest diagnosis defined the index date. All concurrent diagnoses were measured on the index date. Prior COVID diagnosis was assessed using all available data before the index date. Result(s): There were 23,647 patients: 9.9% were African American, 12.1% had Medicaid, and 2.4% were uninsured. There was an overrepresentation of white patients among those with PCC (78.6% compared with 69.6% of the overall EHR in 2021). More African American (24.1%), Medicaid (23.1%), and uninsured (27.5%) patients were diagnosed in the inpatient setting or emergency department than whites (14.0%) and commercially insured patients (10.0%). Among racial groups, African Americans had the highest percentage of documented prior COVID diagnosis at 63.6%. Of concurrent diagnoses, shortness of breath and acute respiratory failure with hypoxia were higher among African Americans (13.9% and 6.1%, respectively) than whites (11.5% and 4.3%, respectively). The same pattern was seen when comparing Medicaid and uninsured to commercial payors. Conclusion(s): The PCC code was used differently across racial groups and payor types and captures varying manifestations of PCC. The differences in diagnosis locations underscore the importance of using data capturing all care settings when conducting studies using this code. Subgroup analyses are important for future studies using U09.9 due to variability in code application.Copyright © 2023
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Background: FSGS is a histologic pattern of glomerular injury with numerous causes, frequently associated with kidney disease progression and kidney failure. Although CVD events are known to be associated with end stage kidney disease (ESKD), there is a paucity of research examining this relationship in the FSGS population. We assessed the impact of baseline proteinuria and eGFR decline to ESKD on CVD event incidence and all-cause mortality. Method(s): A descriptive, retrospective analysis using Optum de-identified Market Clarity and proprietary Natural Language Processed (NLP) Data (2007-2020). Inclusion criteria: Patients (>=18yo) with >=2 FSGS ICD-10 codes (N031, N041, N051, N061, N071) and/or >=2 FSGS NLP terms within 180 days and >=30 days apart without associated negation terms, >6mo pre-index activity (exclusion: COVID-19). Post-index CVD events included myocardial infarction (MI), ischemic stroke/transient ischemic attack (TIA), unstable angina, congestive heart failure (CHF), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). All-cause mortality included patients with a death date post-index. Result(s): Overall (n=7,974), 11.7% of patients with FSGS experienced a CVD event. Post-ESKD, and among patients with higher baseline proteinuria, CVD events and mortality were significantly elevated (p<.001;Table 1). Conclusion(s): A significant increase in CVD events and death was associated with elevated proteinuria and progression to ESKD in patients with FSGS. New therapies for FSGS that reduce proteinuria may reduce CVD events and improve overall survival. (Table Presented).
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Objectives: FSGS is a histologic pattern of glomerular injury with numerous causes, frequently associated with kidney disease progression and kidney failure. We examine the US prevalence of FSGS and the impacts of proteinuria and kidney function decline to end-stage kidney disease (ESKD) on HRU and costs. Methods: Descriptive, retrospective analysis based on Optum® de-identified Market Clarity and proprietary Natural Language Processed (NLP) Data (2007-2020). Inclusion criteria: patients with ≥2 FSGS ICD-10 codes (N0x.1) and/or ≥2 FSGS NLP terms within 180 days and ≥30 days apart without associated negation terms. For patients with available claims data (subset of prevalence cohort), HRU/costs analyses were completed (exclusions: pregnancy, cancer, COVID-19). All costs were normalized/discounted and adjusted to 2020 USD using the Consumer Price Index. Results: Estimated standardized US prevalence of FSGS (2016–2019) is 80.86 per 1,000,000 based on US Census Bureau data. Among 320 patients with proteinuria data in the HRU/cost cohort, 60% and 36% had baseline proteinuria >1.5 or >3.5 g/g, respectively. HRU and costs, all per-patient-per-month (PPPM), increased significantly (p<0.05) with proteinuria levels ˃3.5 g/g;(≤1.5 [n=127] vs ˃1.5–3.5 [n=80] vs ˃3.5 g/g [n=113]: emergency department (ED), 0.13 vs 0.13 vs 0.23;outpatient, 3.03 vs 3.41 vs 6.01;total costs, mean $3,026 vs $4,262 vs $10,227). Advancing chronic kidney disease stage to ESKD (stage I [n=99] vs stage III [n=238] vs ESKD [n=180]: ED, 0.09 vs 0.13 vs 0.33;outpatient, 2.58 vs 3.46 vs 11.11;pharmacy claims, 3.59 vs 4.15 vs 5.00;PPPM total costs, mean $1,895 vs $3,898 vs $12,603) was also associated with significant increases in HRU and costs (p<0.05). Conclusion: For patients with FSGS, worsening proteinuria and progression to ESKD are associated with substantial HRU and costs. Approved therapies for FSGS would improve the lives of patients and reduce substantial burden to the healthcare system.
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Objectives: Globally, IgAN is the most common primary glomerulonephritis and, if not controlled, results in progression to end-stage kidney disease (ESKD). This study examines the US prevalence of IgAN and the impacts of proteinuria and kidney function decline to ESKD on HRU and costs. Methods: Descriptive, retrospective analysis based on Optum® de-identified Market Clarity and proprietary Natural Language Processed (NLP) Data (2007-2020). Inclusion criteria: ≥2 IgAN NLP terms within 180 days at least 30 days apart without associated negation terms. For patients with available claims data (subset of the prevalence cohort), HRU/costs analyses were completed (exclusions: pregnancy, cancer, COVID-19). All costs were normalized/discounted and adjusted to 2020 USD using the Consumer Price Index. Results: Estimated standardized US prevalence of IgAN (2016–2019) is 130.17 per 1,000,000 based on US Census Bureau data. Among 253 patients with proteinuria data in the HRU/costs cohort, 45% had high-risk proteinuria (≥1.0 g/g). HRU (mean outpatient visits, 1.93 vs 4.24;pharmacy claims, 2.69 vs 3.84) and total costs (mean $1,408 vs $3,721), all per-patient-per month (PPPM), are higher (p<0.05) among patients with elevated proteinuria (<1.0 g/g [n=139] vs ≥1.0 g/g [n=114]). Advancing chronic kidney disease stage to ESKD (stage I [n=171] vs stage III [n=171] vs ESKD [n=148]: PPPM outpatient visits, mean 1.84 vs 2.70 vs 7.40;pharmacy claims, 2.30 vs 3.68 vs 4.97;PPPM total costs, mean $1,455 vs $2,499 vs $8,479) was also associated with significantly higher HRU and costs (p<0.05). Conclusions: A substantial proportion of patients with IgAN have elevated proteinuria. Elevated proteinuria and progression to ESKD are associated with a significant HRU and cost burden. Treatments that reduce proteinuria and prevent decline in kidney function have the potential to reduce the resource intensity and economic burden of IgAN.