Table 1.
Selected baseline patient characteristics comparing patients with vs. without a chronic inflammatory skin disease (CISD), unadjusted
| Patient characteristics, within the 365 days before cohort entry |
Non-CISD (referent) |
CISDs |
|||||
|---|---|---|---|---|---|---|---|
| Psoriasis | Atopic dermatitis | Alopecia areata | Vitiligo | Hidradenitis suppurativa |
Composite CISD | ||
| Number of patients | 2 376 120 | 83 049 | 123 614 | 18 135 | 9003 | 6806 | 242 010 |
| Follow-up (days), median (IQR) | 713 (299–1468) | 657 (285–1274) | 869 (351–1891) | 633 (267–1254) | 665 (292–1287) | 523 (221–992) | 736 (312–1533) |
| Demographics | |||||||
| Age (years) | |||||||
| Mean (SD) | 45·4 (21·7) | 49·1 (17·7) | 41·3 (22·4) | 38·5 (17·4) | 39·7 (21·2) | 36·6 (14·5) | 43·6 (20·7) |
| Median (IQR) | 46 (27–63) | 50 (36 −63) | 43 (23–58) | 37 (27–50) | 40 (22–55) | 35 (25–46) | 45·00 (29–59) |
| 0–17 years | 353 210 (14·9) | 3562 (4·3) | 24 783 (20·0) | 2327 (12·8) | 1957 (21·7) | 577 (8·5) | 33 223 (13·7) |
| 18–25 years | 199 065 (8·4) | 4798 (5·8) | 8518 (6·9) | 1758 (9·7) | 526 (5·8) | 1136 (16·7) | 16 766 (6·9) |
| 26–59 years | 1 106 575 (46·6) | 49 445 (59·5) | 61 714 (49·9) | 11 724 (64·6) | 4707 (52·3) | 4565 (67·1) | 133 074 (55·0) |
| ≥ 60 years | 717 270 (30·2) | 25 244 (30·4) | 28 599 (23·1) | 2326 (12·8) | 1813 (20·1) | 528 (7·8) | 58 947 (24·4) |
| sex | |||||||
| Male | 1 004 600 (42·3) | 40 790 (49·1) | 49 545 (40·1) | 7523 (41·5) | 4177 (46·4) | 1547 (22·7) | 104 232 (43·1) |
| Female | 1 371 520 (57·7) | 42 259 (50·9) | 74 069 (59·9) | 10 612 (58·5) | 4826 (53·6) | 5259 (77·3) | 137 778 (56·9) |
| Region | |||||||
| 1 – Northeast | 293 470 (12·4) | 12 992 (15·6) | 20 412 (16·5) | 3364 (18·5) | 1393 (15·5) | 705 (10·4) | 39 010 (16·1) |
| 2 – North Central | 512 420 (21·6) | 21 293 (25·6) | 27 236 (22·0) | 3728 (20·6) | 1788 (19·9) | 1687 (24·8) | 56 086 (23·2) |
| 3 – South | 1 084 186 (45·6) | 36 527 (44·0) | 55 517 (44·9) | 7899 (43·6) | 4249 (47·2) | 3445 (50·6) | 108 276 (44·7) |
| 4 – West | 483 876 (20·4) | 12 148 (14·6) | 20 385 (16·5) | 3124 (17·2) | 1559 (17·3) | 958 (14·1) | 38 440 (15·9) |
| Racea | |||||||
| White | 1 958 321 (82·4) | 64 892 (78·1) | 89 206 (72·2) | 10 714 (59·1) | 5310 (59·0) | 4369 (64·2) | 175 624 (72·6) |
| Asian | 75 284 (3·2) | 4048 (4·9) | 9468 (7·7) | 1815 (10·0) | 1125 (12·5) | 304 (4·5) | 16 824 (7·0) |
| Black | 150 201 (6·3) | 5935 (7·1) | 13 458 (10·9) | 2233 (12·3) | 901 (10·0) | 1274 (18·7) | 23 889 (9·9) |
| Hispanic | 192 314 (8·1) | 8174 (9·8) | 11 482 (9·3) | 3373 (18·6) | 1667 (18·5) | 859 (12·6) | 25 673 (10·6) |
| GI-related conditions | |||||||
| Abdominal/pelvic CT or MRI | 122 650 (5·2) | 4593 (5·5) | 5603 (4·5) | 726 (4·0) | 354 (3·9) | 534 (7·8) | 11 929 (4·9) |
| Fecal pathogen tests (including Clostridioides difficile) ordered | 22 735 (1·0) | 872 (1·0) | 1387 (1·1) | 167 (0·9) | 89 (1·0) | 108 (1 −6) | 2650 (1·1) |
| GI endoscopy (upper or lower) | 182 942 (7·7) | 6646 (8·0) | 8928 (7·2) | 1045 (5·8) | 614 (6·8) | 458 (6·7) | 17 840 (7·4) |
| Hospitalization related to abdominal issues | 83 338 (3·5) | 4092 (4·9) | 1838 (1·5) | 902 (5·0) | 460 (5·1) | 656 (9·6) | 8062 (3·3) |
| Surgery, any abdominal | 14 703 (0·6) | 556 (0·7) | 670 (0·5) | 76 (0·4) | 39 (0·4) | 89 (1·3) | 1438 (0·6) |
| History of C. difficile infection | 2441 (0·1) | 86 (0·1) | 99 (0·1) | 9 (0·0) | 4 (0·0) | 9 (0·1) | 209 (0·1) |
| Gagne combined comorbidity score, mean (SD) b | 0·37 (1·33) | 0·38 (1·34) | 0·29 (1·10) | 0·24 (0·87) | 0·27 (0·99) | 0·53 (1·30) | 0·33 (1·18) |
| Comorbid conditions | |||||||
| Smoking | 94 238 (4·0) | 6072 (7·3) | 4870 (3·9) | 702 (3·9) | 211 (2·3) | 989 (14·5) | 12 995 (5·4) |
| Obesity or weight gain | 199 676 (8·4) | 12 016 (14·5) | 8342 (6·7) | 1746 (9·6) | 825 (9·2) | 2055 (30·2) | 25 362 (10·5) |
| Diabetes, severe or complicated | 96 274 (4·1) | 5364 (6·5) | 3316 (2·7) | 428 (2·4) | 381 (4·2) | 463 (6·8) | 10 080 (4·2) |
| COPD | 221 389 (9·3) | 9172 (11·0) | 14 880 (12·0) | 1508 (8·3) | 782 (8·7) | 911 (13·4) | 27 453 (1 1·3) |
| Alcohol abuse | 19 153 (0·8) | 1130 (1·4) | 893 (0·7) | 166 (0·9) | 38 (0·4) | 101 (1·5) | 2346 (1·0) |
| Anaemia | 148 179 (6·2) | 5416 (6·5) | 8508 (6·9) | 1149 (6·3) | 588 (6·5) | 609 (8·9) | 16 394 (6·8) |
| Weight loss | 17 167 (0·7) | 566 (0·7) | 413 (0·3) | 112 (0·6) | 55 (0·6) | 66 (1·0) | 1226 (0·5) |
| Pregnancy | 28 341 (1·2) | 827 (1·0) | 1432 (1·2) | 160 (0·9) | 76 (0·8) | 152 (2·2) | 2655 (1·1) |
| Acne | 571 358 (24·0) | 5084 (6·1) | 16 900 (13·7) | 2324 (12·8) | 983 (10·9) | 1943 (28·5) | 27 296 (11·3) |
| Uveitis | 1789 (0·1) | 75 (0·1) | 117 (0·1) | 9 (0·0) | 7 (0·1) | 6 (0·1) | 216 (0·1) |
| Connective tissue disease | 15 416 (0·6) | 597 (0·7) | 1081 (0·9) | 255 (1·4) | 108 (1 −2) | 78 (1·1) | 2164 (0·9) |
| Other medications | |||||||
| Contraceptive agents | 311 128 (13·1) | 8158 (9·8) | 16 824 (13·6) | 2505 (13·8) | 950 (10·6) | 1673 (24·6) | 30 243 (12·5) |
| Oral retinoids | 38 424 (1·6) | 1680 (2·0) | 1487 (1·2) | 47 (0·3) | 33 (0·4) | 294 (4·3) | 3558 (1·5) |
| NSAIDs and Coxibs | 291 844 (12·3) | 12 514 (15·1) | 15 855 (12·8) | 2259 (12·5) | 1140 (12·7) | 1418 (20·8) | 33 729 (13·9) |
| Systemic glucocorticoid use | |||||||
| Prior use, past 180 days | 295 760 (12·4) | 14 602 (17·6) | 31 566 (25·5) | 2683 (14·8) | 1161 (12·9) | 1360 (20·0) | 51 821 (21·4) |
| Recent use, past 30 days | 46 146 (1·9) | 2178 (2·6) | 7917 (6·4) | 377 (2·1) | 172 (1 −9) | 170 (2·5) | 10 884 (4·5) |
| Sum of daily dose in prednisone mg eq., mean (SD) | 44·5 (298) | 68·8 (311) | 108 (384) | 59·8 (327) | 44·5 (222) | 78·4 (342) | 88·3 (352) |
| DMARD use | |||||||
| Conventional synthetic | 4960 (0·2) | 5278 (6·4) | 874 (0·7) | 136 (0·7) | 26 (0·3) | 41 (0·6) | 6835 (2·8) |
| DMARDsb | |||||||
| Biologic DMARDsc | |||||||
| TNFid | 231 (0·0) | 8384 (10·1) | 79 (0·1) | 13 (0·1) | 7 (0·1) | 527 (7·7) | 9673 (4·0) |
| Non-TNFie | 669 (0·0) | 5019 (6·0) | 270 (0·2) | 27 (0·1) | 2 (0·0) | 9 (0·1) | 5568 (2·3) |
| Targeted synthetic DMARDsf | 1 (0·0) | 1 (0·0) | 1 (0·0) | 20 (0·1) | 1 (0·0) | 1 (0·0) | 29 (0·0) |
| Number of prior unique DMARDs | |||||||
| 0 | 2 369 422 (99·7) | 64 990 (78·3) | 122 290 (98·9) | 17 926 (98·8) | 8958 (99·5) | 6213 (91·3) | 220 678 (91·2) |
| 1 | 5800 (0·2) | 14 756 (17·8) | 1162 (0·9) | 163 (0·9) | 41 (0·5) | 562 (8·3) | 17 275 (7·1) |
| 2 | 846 (0·0) | 2721 (3·3) | 135 (0·1) | 39 (0·2) | 3 (0·0) | 26 (0·4) | 3247 (1·3) |
| ≥ 3 | 52 (0·0) | 582 (0·7) | 27 (0·0) | 7 (0·0) | 1 (0·0) | 5 (0·1) | 810 (0·3) |
| Healthcare utilization | |||||||
| Number of any outpatient visits | |||||||
| Mean (SD) | 5·83 (4·86) | 7·26 (5·73) | 8·00 (6·16) | 6·18 (4·97) | 6·57 (5·79) | 8·46 (6·57) | 7·38 (5·68) |
| Median (IQR) | 4 (3–7) | 6 (4–9) | 6 (4–10) | 5 (3–8) | 5 (3–8) | 7 (4–H) | 6 (4–9) |
| Number of unique medications | |||||||
| Mean (SD) | 5·42 (5·04) | 7·57 (5·87) | 7·42 (5·68) | 5·00 (4·77) | 5·50 (4·97) | 8·63 (6·39) | 7·27 (5·75) |
| Median (IQR) | 4 (2–8) | 6 (3–10) | 6 (3–10) | 4 (2–7) | 4 (2–8) | 7 (4–11) | 6 (3–10) |
| Number of CRP tests ordered, mean (SD) | 0·06 (0·35) | 0·09 (0·42) | 0·07 (0·39) | 0·08 (0·36) | 0·08 (0·36) | 0·11 (0·57) | 0·09 (0·42) |
| Gastroenterologist visit | 228 018 (9·6) | 8677 (10·4) | 12 115 (9·8) | 1479 (8·2) | 856 (9·5) | 647 (9·5) | 23 987 (9·9) |
| Hospitalization | 144 535 (6·1) | 5001 (6·0) | 7255 (5·9) | 582 (3·2) | 323 (3·6) | 543 (8·0) | 13 811 (5·7) |
The data are presented as n (%) unless stated otherwise. This table shows selected patient characteristics, please see Table S2 in the Supporting Information for a full table. COPD, chronic obstructive pulmonary disease; CT, computed tomography scan; DMARD, disease-modifying antirheumatic drug; GI, gastrointestinal; HS, hidradenitis suppurativa; IQR, interquartile range; MRI, magnetic resonance imaging; TNFi, tumour necrosis factor inhibitor.
Optum uses proprietary algorithms to define race. Race is a derived ethnicity. The member’s ethnicity is derived using the member’s name and geography. Once the ethnicity is determined, the member is mapped to one of four race categories (A, Asian; B, black; H, Hispanic; w, white).
Nonbiologic immunomodulators were defined as methotrexate, ciclosporin, mycophenolate mofetil, azathioprine, sulfasalazine, leflunomide.
Biologic immunomodulators were defined as adalimumab, etanercept, golimumab, certolizumab, infliximab, dupilumab, risankizumab-rzaa, tildrakizumab, ixekizumab, secukinumab, guselkumab, ustekinumab, abatacept, rituximab, anakinra, tocilizumab.
TNF inhibitor biologic immunomodulators were defined as adalimumab, etanercept, golimumab, certolizumab, infliximab.
Non-TNF inhibitor biologic immunomodulators were defined as dupilumab, risankizumab-rzaa, tildrakizumab, ixekizumab, secukinumab, guselkumab, ustekinumab, abatacept, rituximab, anakinra, tocilizumab.
Targeted synthetic immunomodulators were defined as tofacitinib or baricitinib.