Comorbidity network of chronic, non-communicable inflammatory diseases

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Chronic, non-communicable inflammatory diseases (CIDs) impose a major medical burden. This is due to their high prevalence, the lack of curative treatment options and a high comorbidity. Regarding the latter, patients diagnosed with a given CID, e.g., psoriasis, rheumatoid arthritis, or celiac disease, have an increased risk to develop cardiovascular and metabolic comorbidity. Notably, the risk to develop an additional CID is also increased. This presumed risk for the development of additional CIDs is, however, a matter of lively controversy for most CIDs. These discrepancies may stem from differences in the cohorts, as sex-, age- and/or race-specific risks have not been addressed in most studies. Regarding rare or orphan CIDs, reports on the inflammatory comorbidity are sparse at best. Insights into the inflammatory comorbidity of CID patients would improve disease management because screening for and early treatment of comorbid CID would potentially better treatment outcomes. Furthermore, co-occurrence of CIDs potentially points towards shared pathogenic pathways, thus allowing future insights into disease pathogenesis. Addressing the inflammatory comorbidity of CIDs has, in the past, been hampered by limited availability to large databases and/or prospective patient registries. We recently obtained access to TriNetX, a database including over 120 million electronic medical records (EMRs). These EMRs include longitudinal data on demographics, diagnoses, medications, and laboratory findings. Therefore, we are now in the unique position to address the inflammatory comorbidity of CIDs. For this, we will contrast the risk to develop any one of 50 selected CIDs in patients diagnosed with each one of the CIDs to propensity matched controls that had not been diagnosed with any CID upon inclusion into the study. Project-related preliminary work determined the sample size and evaluated the approach by running the analysis for one of the selected CIDs, namely celiac disease. Here, we confirmed already established risks, as well as identified novel risks regarding the immunological comorbidity of celiac disease. Validation of the obtained data will be done by use of additional networks within TriNetX. Our analysis will also include determination of the sex-, age and race-specific risks for the inflammatory comorbidity of CIDs. At completion, we will have generated a comorbidity/risk network of chronic, non-communicable inflammatory diseases. This will be useful for clinical care as well as provide insights into potentially shared pathogenic pathways.