2. Disclosure belangen NHG spreker
(Potentiële) belangenverstrengeling
Nvt
Voor bijeenkomst mogelijk relevante relaties met bedrijven
Sponsoring of onderzoeksgeld
Honorarium of andere (financiële) vergoeding
Aandeelhouder
Andere relatie, namelijk …
GlaxoSmithKline

3. 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

4. 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

5. 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

6. 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 ( )
Osteoarthritis
11.5
8.4
13.7
1.80 ( )
Eczema
10.7
12.1
1.17 ( )
Dyspepsia, GERD
10.1
11.2
1.10 ( )
COPD
9.5
8.6
0.72 ( )
Diabetes
8.5
0.92 ( )
Dyslipidemia
6.9
6.8
0.93 ( )
Chronic sinusitis
6.6
4.7
7.9
1.73 ( )
Obesity
6.5
4.4
8.0
1.88 ( )
Coronary heart disease
8.3
5.3
0.52 ( )
Blindness & low vision
6.1
5.6
6.4
1.05 ( )
Peripheral vascular disease
5.5
0.96 ( )
Irritable bowel syndrome
5.4
2.7
7.3
2.84 ( )
Thyroid disorder
5.1
1.6
7.4
5.00 ( )

7. 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

8. 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