Geographic variations in rheumatoid arthritis treatment in Japan: A nationwide retrospective study using the national database of health insurance claims and specific health checkups of Japan
Geographic variations in rheumatoid arthritis treatment in Japan: A nationwide retrospective study using the national database of health insurance claims and specific health checkups of Japan
复制标题
DOI：
10.1080/14397595.2021.1910615
复制
发表时间：
2021-04-14
影响因子：
2.2
通讯作者：
Harigai, Masayoshi
中科院分区：
文献类型：
--
作者：
Nakajima, Ayako;Sakai, Ryoko;Harigai, Masayoshi
目的了解日本不同机构类型和地区类风湿关节炎（RA）的治疗特点。方法利用日本2017财政年度健康保险理赔额和特定健康检查的国家数据库，研究82.5万名RA患者的疾病改善抗风湿药物（DMARD）和口服皮质类固醇处方趋势。这些数据在专业和非专业机构之间以及按地区进行了比较。风湿性关节炎专业机构（si）被定义为在日本风湿病学院风湿病学培训计划中注册的机构或雇用委员会认证的风湿病学家的机构。结果患者从未去过SI的总比例为31.8%，并且随着年龄的增长而增加（16-29岁= 15.6%;bb0 = 80岁= 42.8%）。在12个县（25.5%），从未访问过SI的患者比例至少比总体平均水平高10%。仅到医院就诊并服用甲氨蝶呤和生物类dmard的患者比例分别为51.9 ~ 72.9%和19.5 ~ 33.2%。然而，从未访问过SI并开过这些药物的患者分别为44.0-71.6%和7.2-28.0%。结论本研究首次采用日本NDB数据库对地区和机构专科类风湿关节炎治疗趋势进行评价。在日本，RA患者访问SI的机会分布不均，影响了所提供治疗的某些方面。
ObjectivesTo characterize the treatments for rheumatoid arthritis (RA) among institution types and prefectures in Japan.MethodsUsing the National Database of Health Insurance Claims and Specific Health Checkups of Japan in the 2017 fiscal year, we investigated disease-modifying antirheumatic drug (DMARD) and oral corticosteroid prescription trends across 825 thousand RA patients. These data were compared between specialized and non-specialized institutions and by prefecture. RA specialized institutions (SIs) were defined as either institutions registered in the rheumatology training program at the Japan College of Rheumatology or institutions where board-certified rheumatologists were employed.ResultsThe overall percentage of patients who never visited an SI was 31.8% and increased with age (16-29 years old = 15.6%; >= 80 years = 42.8%). In twelve prefectures (25.5%), the proportions of patients who never visited an SI were at least 10% higher than the overall average. The proportions of patients who only visited SIs and were prescribed methotrexate and biological DMARDs were ranged from 51.9-72.9% and 19.5-33.2%, respectively. However, those of patients who had never visited an SI and were prescribed those medications were 44.0-71.6% and 7.2-28.0%, respectively.ConclusionsThis is the first study evaluating the trends in RA treatments by prefecture and institution specialty by using the NDB Japan. Opportunities of patients with RA for visiting SI was unevenly distributed in Japan, affecting some aspects of treatment provided.