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Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care
Enma Marianela Morales-Espinoza1, Belchin Kostov1, Daniel Cararach Salami1
1Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Insights
Chronic widespread pain (CWP) affects 5.51% of the population, significantly impacting quality of life and increasing healthcare costs. Patients with CWP experience worse health outcomes and incur nearly triple the annual healthcare expenses compared to controls.
Area of Science:
- Rheumatology
- Epidemiology
- Public Health
Background:
- Chronic widespread pain (CWP) represents a significant health burden with unclear prevalence and comprehensive impact.
- Understanding the multifaceted consequences of CWP is crucial for effective healthcare management and resource allocation.
Purpose of the Study:
- To estimate the prevalence of CWP in a primary care setting.
- To compare quality of life (QoL), cardiovascular risk factors, comorbidity, complexity, and healthcare costs in patients with CWP versus a reference population.
Main Methods:
- A multicenter case-control study involving 3048 randomized patients across 3 primary care centers.
- CWP diagnosis based on American College of Rheumatology criteria.
- Assessment of QoL, disability, fatigue, anxiety, depression, sleep quality, cardiovascular risk, comorbidity (Charlson index), clinical complexity (Clinical Risk Groups), and healthcare costs.
Main Results:
- CWP prevalence was 5.51% (95% CI: 4.75%-6.38%), predominantly affecting women (92.3%).
- CWP patients exhibited significantly worse QoL, higher disability, increased rates of anxiety, depression, sleep disturbances, obesity, hypertension, diabetes, and cardiovascular events.
- CWP was associated with greater clinical complexity, severity, hospitalization, mortality, and substantially higher annual healthcare costs (&OV0556;3751 vs &OV0556;1397).
Conclusions:
- Individuals with CWP experience diminished QoL and a heightened burden of mental health disorders and cardiovascular risk.
- The annual healthcare cost for CWP patients is nearly threefold that of individuals without CWP, even after adjusting for clinical factors.
- Findings underscore the need for integrated disease management strategies and informed budgetary planning for CWP.
Abstract:
The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case-control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P < 0.001), and greater disability (1.04 vs 0.35; P < 0.001), anxiety (43.9% vs 13.3%; P < 0.001), depression (27% vs 5.8%; P < 0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus, and number of cardiovascular events (13.1% vs 4.8%; P = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were &OV0556;3751 per year in patients with CWP vs &OV0556;1397 in controls (P < 0.001). In conclusion, the average patient with CWP has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations.
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