Frederik V Ilkjær1,2, Line D Rasmussen3, Raquel Martin-Iguacel3, Lena Westh4, Terese L Katzenstein5, Ann-Brit E Hansen6, Thyge L Nielsen7, Carsten S Larsen4,8, Isik S Johansen3. 1. Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark. Frederik.veitland.antonsen2@rsyd.dk. 2. Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9a, Odense, Denmark. Frederik.veitland.antonsen2@rsyd.dk. 3. Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark. 4. Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark. 5. Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark. 6. Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Kettegaard Allé 30, Copenhagen, Denmark. 7. Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Dyrehavevej 29, Hilleroed, Denmark. 8. International Center of Immunodeficiency Diseases, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, Aarhus, Denmark.
Abstract
PURPOSE: Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations. METHODS: We conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997-2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: The median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9-15 consultations compared with 1-4 was associated with an OR (95%CI) of 5.0 (2.3-10.9), 2.4 (1.1-5.4), and 1.3 (0.3-5.3) for those aged 18-40, 41-60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis. CONCLUSION: The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old.
PURPOSE: Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations. METHODS: We conducted a nested case-control study, identifying 132 adult CVIDpatients and 5940 age- and gender-matched controls from national registers during 1997-2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: The median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9-15 consultations compared with 1-4 was associated with an OR (95%CI) of 5.0 (2.3-10.9), 2.4 (1.1-5.4), and 1.3 (0.3-5.3) for those aged 18-40, 41-60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis. CONCLUSION: The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old.
Entities:
Keywords:
CVID; PID; consultations; diagnostic delay; indicators; primary health care
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