Health care utilisation before and after intensive care unit admission in rheumatoid arthritis

We evaluated the incidence of intensive care unit (ICU) admission in a rheumatoid arthritis (RA) population according to health care utilisation and use of immune therapies in the year preceding admission. Also, we compared health care utilisation after ICU admission in persons with and without RA.

We identified all persons with RA in Manitoba, Canada using population-based administrative data, and controls matched by age, sex, and region of residence. ICU admissions were identified using special care unit codes included in hospital discharge abstracts. We estimated the annual incidence rate of ICU admission in the RA population according to health care utilisation using generalised linear models, adjusting for age, sex, comorbidity, region and socioeconomic status. We compared health care utilisation post-ICU admission in persons with and without RA.

From 2000/01 through 2009/10, the average annual incidence of ICU admission was 1.26% in the RA population. Corticosteroid use was associated with an increased incidence of ICU admission (IRR 1.07; 95%CI: 1.05, 1.09). Use of disease-modifying anti-rheumatic drugs and biologics was not associated with an increased incidence of ICU admission. In the year following ICU admission, 45.3% of the RA population was re-hospitalised, and 8.9% were readmitted to the ICU.

Persons with RA who are admitted to the ICU have higher rates of health care utilisation in the year before ICU admission than those who are not admitted. Corticosteroid use is associated with an increased risk of ICU admission even after accounting for other health care utilisation.