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Geslachts- en leeftijdsspecifieke prevalentie van chronische comorbiditeit bij volwassenen met astma in de huisartsenpraktijk Mathijs Veenendaal, Janine Westerik, Lisette van den Bemt, Janwillem Kocks, Erik Bischoff, Tjard Schermer 8 juni 2018 NHG Wetenschapsdag

Background Comorbidity associated with poorer asthma control (Chen, 2015) Identification & management of comorbidity increasingly recognized as important part of asthma management (GINA, 2017) Previous studies mainly looked at hospital populations, specific age groups (children, elderly), or limited selection of conditions Aims (Overall aim: study association between comorbidity and asthma exacerbation risk) Estimate prevalence of the full range of chronic comorbid conditions in adult asthma patients in real-life general practice Differences in these prevalence estimates between the sexes and age groups

Design Retrospective dynamic cohort study EHR data from 32,787 asthma patients from 179 practices Calculation of period prevalence: 1/1/2012 – 31/12/2013 Exclusion: - age < 16 years - no asthma-related consultations with GP and - no prescriptions for asthma medication in the past year 76 chronic conditions selected based on literature Dutch GP guideline criteria used to define chronicity, e.g. urinary tract infection: ≥3 episodes/year, ≥8 weeks in between (similar for depression, anxiety, dyspepsia, migraine, sinusitis, gout) Clustering comorbid conditions in 14 disease categories ‘active asthma’ Recorded data included date of diagnosing asthma, date of diagnosing COPD, dates of prescribing ICS, year of birth, gender, general practice, contacts with the general practitioner related to COPD or astmaand additional respiratory drugs. Medisch ethisch

Prevalence estimates of chronic comorbid diseases in adult asthma (Odds ratios adjusted for age) Total (%) males females OR, female vs male (95%CI) Hypertension 20.1 18.0 21.6 1.26 (1.18-1.34) Osteoarthritis 11.5 8.4 13.7 1.80 (1.66-1.95) Eczema 10.7 12.1 1.17 (1.09-1.25) Dyspepsia, GERD 10.1 11.2 1.10 (1.02-1.18) COPD 9.5 8.6 0.72 (0.67-0.78) Diabetes 8.5 0.92 (0.85-1.00) Dyslipidemia 6.9 6.8 0.93 (0.85-1.02) Chronic sinusitis 6.6 4.7 7.9 1.73 (1.57-1.90) Obesity 6.5 4.4 8.0 1.88 (1.70-2.07) Coronary heart disease 8.3 5.3 0.52 (0.48-0.58) Blindness & low vision 6.1 5.6 6.4 1.05 (0.94-1.16) Peripheral vascular disease 5.5 0.96 (0.87-1.06) Irritable bowel syndrome 5.4 2.7 7.3 2.84 (2.53-3.20) Thyroid disorder 5.1 1.6 7.4 5.00 (4.32-5.80)

Average number of chronic comorbid diseases by age and sex Age (years) Men (range) Women p* 16-29 0.52 (0-5) 0.72 (0-7) <0.001 30-44 0.86 (0-8) 1.18 (0-8) 45-59 1.72 (0-11) 2.05 (0-12 60-74 3.26 (0-17) 3.49 (0-14) 0.023 75+ 5.02 (0-14) 5.01 (0-18) 0.974 Total 1.72 (0-17) 2.03 (0-18) Prevalence of disease categories by age group

Conclusions Study provides comprehensive overview of prevalence estimates for the full range of chronic comorbid conditions in adults with asthma Chronic comorbidity highly prevalent in adult asthma: 70% has ≥1 comorbid conditions, average of ~2 Female asthma patients have more chronic comorbidity than male patients, until the age of ~75 Next step: study association between chronic comorbidity and asthma exacerbations