The Impact of Psychiatric Comorbidity on Health Care Utilization for Youth with Newly Diagnosed Systemic Lupus Erythematosus.
Objective: To examine the impact of psychiatric diagnoses on health care use in youth with systemic lupus erythematosus (SLE) during their first year of SLE care.
Methods: We conducted a retrospective cohort study using claims for 2000 to 2013 from ClinformaticsTM DataMart (OptumInsight, Eden Prairie, MN). Youth ages 10-24 years with an incident diagnosis of SLE (≥3 International Classification of Diseases, Ninth Revision codes for SLE 710.0, >30 days apart) were categorized as having: 1) a preceding psychiatric diagnosis in the year before SLE diagnosis, 2) an incident psychiatric diagnosis in the year after SLE diagnosis, or 3) no psychiatric diagnosis. We compared ambulatory, emergency, and inpatient visits in the year after SLE diagnosis, stratified by non-psychiatric and psychiatric visits. We examined the effect of childhood-onset versus adult-onset SLE by testing for an interaction between age and psychiatric exposure on outcome.
Results: We identified 650 youth with an incident diagnosis of SLE, of which 122 (19%) had a preceding psychiatric diagnosis and 105 (16%) had an incident psychiatric diagnosis. Compared with those without a psychiatric diagnosis, youth with SLE and a preceding or incident psychiatric diagnosis had more health care use across both ambulatory and emergency settings for both non-psychiatric and psychiatric-related care. These associations were minimally affected by age at time of SLE diagnosis.
Conclusions: Psychiatric comorbidity is common among youth with newly diagnosed SLE and associated with greater health care use. Interventions to address preceding and incident psychiatric comorbidity may decrease health care burden for youth with SLE.