Marios Rossides1, Susanna Kullberg2, Anders Eklund2, Johan Grunewald2, Elizabeth V Arkema3. 1. Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: marios.rossides@ki.se. 2. Respiratory Medicine Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Respiratory Medicine, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden. 3. Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: In Sweden, sarcoidosis prevalence varies geographically, but it is unclear whether diagnosis and treatment patterns vary by geographical area and calendar period. We sought to investigate differences in sarcoidosis diagnosis and treatment by healthcare region and calendar period using nationwide register data. METHODS: We included 4777 adults who had at least two ICD-coded visits for sarcoidosis in the National Patient Register (2007-2012). We compared patterns of healthcare use (visits and medication dispensations), and data on sarcoidosis diagnosis and treatment spanning two years before to two years after diagnosis stratified by healthcare region and calendar period at diagnosis. RESULTS: Compared to other regions, individuals diagnosed in Stockholm were younger, more likely female, and had a higher education level. In all regions, there was an increase in healthcare use at least six months before sarcoidosis diagnosis with small variation among regions. Most patients were diagnosed in pulmonary and internal medicine outpatient clinics, but compared to the national average more patients were diagnosed in rheumatology in the West and ophthalmology and cardiology in the South. Corticosteroid dispensations at diagnosis varied widely by region (48% in the South/Southeast vs. 30% in Stockholm/North). Demographic factors could not explain these differences. We found no differences by calendar period. CONCLUSION: Our findings suggest a six-month delay in sarcoidosis diagnosis irrespective of region. The observed regional variation likely reflects differences in diagnosis and treatment patterns. Stakeholders should ensure diagnosis and treatment recommendations are closely followed.
BACKGROUND: In Sweden, sarcoidosis prevalence varies geographically, but it is unclear whether diagnosis and treatment patterns vary by geographical area and calendar period. We sought to investigate differences in sarcoidosis diagnosis and treatment by healthcare region and calendar period using nationwide register data. METHODS: We included 4777 adults who had at least two ICD-coded visits for sarcoidosis in the National Patient Register (2007-2012). We compared patterns of healthcare use (visits and medication dispensations), and data on sarcoidosis diagnosis and treatment spanning two years before to two years after diagnosis stratified by healthcare region and calendar period at diagnosis. RESULTS: Compared to other regions, individuals diagnosed in Stockholm were younger, more likely female, and had a higher education level. In all regions, there was an increase in healthcare use at least six months before sarcoidosis diagnosis with small variation among regions. Most patients were diagnosed in pulmonary and internal medicine outpatient clinics, but compared to the national average more patients were diagnosed in rheumatology in the West and ophthalmology and cardiology in the South. Corticosteroid dispensations at diagnosis varied widely by region (48% in the South/Southeast vs. 30% in Stockholm/North). Demographic factors could not explain these differences. We found no differences by calendar period. CONCLUSION: Our findings suggest a six-month delay in sarcoidosis diagnosis irrespective of region. The observed regional variation likely reflects differences in diagnosis and treatment patterns. Stakeholders should ensure diagnosis and treatment recommendations are closely followed.
Authors: Marios Rossides; Susanna Kullberg; Anders Eklund; Daniela Di Giuseppe; Johan Grunewald; Johan Askling; Elizabeth V Arkema Journal: Eur Respir J Date: 2020-09-03 Impact factor: 16.671
Authors: Marios Rossides; Susanna Kullberg; Johan Grunewald; Anders Eklund; Daniela Di Giuseppe; Johan Askling; Elizabeth V Arkema Journal: Heart Date: 2021-05-21 Impact factor: 5.994