Comorbidity network of chronic, non-communicable inflammatory diseases

慢性非传染性炎症性疾病(CID)造成了重大的医疗负担。这是由于它们的高患病率、缺乏治愈的治疗选择和高度的共病。对于后者，被诊断为特定CID的患者，如牛皮癣、类风湿性关节炎或乳糜泻，患心血管和代谢共病的风险增加。值得注意的是，发生额外的CID的风险也增加了。然而，对于大多数CID来说，这种对发展更多CID的假定风险是一个激烈争议的问题。这些差异可能源于队列中的差异，因为大多数研究都没有考虑到性别、年龄和/或种族的特定风险。对于罕见或孤儿的CID，有关炎性共病的报道充其量也是稀少的。深入了解CID患者的炎性共病将改善疾病管理，因为筛查和早期治疗合并CID可能会获得更好的治疗结果。此外，共同出现的CIDs可能指向共同的致病途径，从而使未来能够深入了解疾病的发病机制。在过去，由于大型数据库和/或未来患者登记的可获得性有限，解决CID的炎性并存问题一直受到阻碍。我们最近获得了TriNetX的访问权限，这是一个包含超过1.2亿电子病历(EMR)的数据库。这些EMR包括关于人口统计学、诊断、药物和实验室结果的纵向数据。因此，我们现在处于独特的地位来解决CIDs的炎症性并存问题。为此，我们将比较在诊断为每一种CID的患者中发生50种选定CID的风险与纳入研究时未被诊断为任何CID的倾向匹配的对照组。与项目有关的前期工作确定了样本量，并通过对选定的乳糜泻之一进行分析，对方法进行了评估。在这里，我们确认了已经确定的风险，以及确定了与乳糜泻的免疫共病有关的新风险。将利用TriNetX内部的其他网络对所获得的数据进行验证。我们的分析还将包括确定CID的炎症性共病的性别、年龄和种族特定的风险。在完成时，我们将产生一个慢性、非传染性炎症性疾病的共病/风险网络。这将对临床护理有用，并提供对潜在共同致病途径的洞察。

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.