Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Background: Interstitial lung diseases (ILDs) are associated with a high burden of disease. However, data on the prognostic impact of comorbidities and comorbidity-related pharmaceutical treatments in patients with various ILDs remain sparse. Methods: Using longitudinal claims data from a German Statutory Health Insurance Fund, we assessed comorbidity in ILD subtypes and associated drug treatments. Baseline comorbidity was assessed via the Elixhauser Comorbidity Index that was amended by ILD-relevant conditions. Drug treatment was assessed on the substance level using the ATC-codes of drugs prescribed at the time of ILD diagnosis. Subsequently, the comorbid conditions (main analysis) and pharmaceutical substances (secondary analysis) with a meaningful association to survival were identified for the complete ILD cohort and within the subtype strata. For this, we applied multivariate Cox models using a LASSO selection process and visualized the findings within comorbidomes. Results: In the 36,821 patients with ILDs, chronic obstructive pulmonary disease (COPD), arterial hypertension, and ischaemic heart disease (IHD) were the most prevalent comorbidities. The majority of patients with cardiovascular diseases received pharmaceutical treatment, while, in other relevant comorbidities, treatment quotas were low (COPD 46%, gastro-oesophageal reflux disease 65%). Comorbidities had a clinically meaningful detrimental effect on survival that tended to be more pronounced in the case of untreated conditions (e.g. hazard ratios for treated IHD 0.97 vs. 1.33 for untreated IHD). Moreover, comorbidity impact varied substantially between distinct subtypes. Conclusions: Our analyses suggest that comorbid conditions and their treatment profile significantly affect mortality in various ILDs. Therefore, comprehensive comorbidity assessment and management remains important in any ILD

Quality of life assessment in interstitial lung diseases:a comparison of the disease-specific K-BILD with the generic EQ-5D-5L

Background: Patients with interstitial lung diseases (ILD) have impaired health-related quality of life (HRQL). Little is known about the applicability of the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) and the generic EQ-5D-5L in a German setting. Methods: We assessed disease-specific (K-BILD) and generic HRQL (EQ-5D experience based value set (EBVS) and Visual Analog Scale (VAS)) in 229 patients with different ILD subtypes in a longitudinal observational study (HILDA). Additionally, we assessed the correlation of the HRQL measures with lung function and comorbidities. In a linear regression model, we investigated predictors (including age, sex, ILD subtype, FVC percentage of predicted value (FVC%pred), DLCO percentage of predicted value, and comorbidities). Results: Among the 229 patients mean age was 63.2 (Standard deviation (SD): 12.9), 67.3% male, 24.0% had idiopathic pulmonary fibrosis, and 22.3% sarcoidosis. Means scores were as follows for EQ-5D EBVS 0.66(SD 0.17), VAS 61.4 (SD 19.1) and K-BILD Total 53.6 (SD 13.8). K-BILD had good construct validity (high correlation with EQ-5D EBVS (0.71)) and good internal consistency (Cronbach’s alpha 0.89). Moreover, all HRQL measures were highly accepted by patients including low missing items and there were no ceiling or floor effects. A higher FVC % pred was associated with higher HRQL in all measures meanwhile comorbidities had a negative influence on HRQL. Conclusions: K-BILD and EQ-5D had similar HRQL trends and were associated similarly to the same disease-related factors in Germany. Our data supports the use of K-BILD in clinical practice in Germany, since it captures disease specific effects of ILD. Additionally, the use of the EQ-5D-5L could provide comparison to different disease areas and give an overview about the position of ILD patients in comparison to general population

Additional file 10: of Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Figure S2. Comorbidity prevalence in main analysis compared with sensitivity analyses. (DOC 104 kb

Additional file 6: of Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Table S4. Baseline characteristics of the study sample within Sensitivity Analysis 2. (DOC 56 kb

Additional file 5: of Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Figure S3. Pneumoconios-, Drug-associated ILD-, Radiation-asscociated pneumonitis-, Eosinophilic pneumonia-, HP- and CTD-specific comorbidomes based on results of the LASSO selection for the comorbidity-only Cox model. (DOC 648 kb

Additional file 2: of Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Table S1. Baseline characteristics for the population stratified by ILD subtype. (DOC 81 kb

Additional file 9: of Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Table S7. Associations of clinical characteristics and survival within the sensitivity analyses. (DOC 146 kb

Additional file 8: of Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Table S6. Proportion of treated comorbid conditions according to sensitivity analyses. (DOC 60 kb

Additional file 1: of Quality of life assessment in interstitial lung diseases:a comparison of the disease-specific K-BILD with the generic EQ-5D-5L

Baseline characteristics stratified by clinic. (DOCX 17 kb