Rheumatoid Arthritis Linked With Heightened Risk of Avoidable Hospitalizations

People with rheumatoid arthritis have a significantly higher risk of avoidable hospitalizations in the years after their diagnosis, a new study shows. The risk is particularly high for hospitalizations related to heart failure and pulmonary edema, according to the study, which was published in Arthritis Care & Research.1

One common way to assess the performance of a health system is by looking at rates of “avoidable” hospitalizations among its patient population. The idea is that if a health system has a strong and easily accessible primary care program, patients will be able to avoid certain health conditions or deal with them in an outpatient setting, the authors explained.

The authors wanted to better understand the problem of avoidable hospitalizations among people with rheumatoid arthritis. | Image credit: everythingpossible - stock.adobe.com

They noted that a list of ambulatory care sensitive conditions (ACSCs) was developed by the Canadian Institute for Health Information to spotlight “conditions for which appropriate ambulatory care would prevent or reduce the need for hospital admission.” That list includes things like chronic lower respiratory disease, asthma, diabetes, hypertension, heart failure and pulmonary edema, and angina.2

The authors wanted to better understand the problem of avoidable hospitalizations among people with rheumatoid arthritis.1 However, they explained that the existing literature on the subject is thin. A single Taiwanese study suggested that people with rheumatoid arthritis had a 61% greater risk of avoidable hospitalizations compared to the general public.3 The new study sought to determine how the data looked in a Canadian context, noting that Canada has a universal health care system and a strong collection of health data.

The authors used a number of data sets to identify 83,811 people in Alberta, Canada, with rheumatoid arthritis and then found non–rheumatoid arthritis controls from the general population who were matched to each member of the rheumatoid arthritis cohort by age and sex. They then identified hospitalizations for ACSCs among the 2 cohorts and used those data to calculate incidence rate ratios (IRRs) for 3 and 5 years after the patient with RA was diagnosed.

For all ACSCs combined, the investigators found that people with rheumatoid arthritis had an 11% higher risk of avoidable hospitalization within 3 years of diagnosis (RR, 1.11; 95% CI, 1.03-1.19) and a 14% higher risk at 5 years (IRR, 1.14; 95% CI, 1.08-1.20). Those data points were adjusted for age, sex, and geographic location, the authors noted.

When the investigators looked at particular ACSCs, they found people with rheumatoid arthritis had a notably higher risk of hospitalization for heart failure and pulmonary edema, both common comorbidities in people with rheumatoid arthritis (IRR, 1.12; 95% CI, 1.01-1.25). Older age, exposure to glucocorticoids, and comorbidities were risk factors for avoidable hospitalizations, they found.

Exposure to disease-modifying antirheumatic drugs did not protect against ACSC hospitalizations, a finding that the authors said was unexpected. They also noted that people who lived in rural areas had a higher risk of ACSC hospitalization. The investigators said their findings underscore the need for better access to care.

“Appropriate access to primary and specialty health care providers could help patients with rheumatoid arthritis reduce complications and inflammation through treatment and follow-up,” they said. “Consequently, lack of access can lead to worse health outcomes and an increase in acute care use.”

The authors said their study is subject to certain limitations, including the possibility that their diagnostic criteria did not identify all applicable rheumatoid arthritis cases, and the potential for confounding factors to skew the data. They were also not able to assess the data for the impact of socioeconomic status, ethnicity, and other non-medical characteristics that may impact hospitalization risk.

In addition to improving access to care, the authors said the results show the importance of care coordination.

“There is a need for better collaborative, team-driven care that may consist of the patient's general practitioner, rheumatologist, and specialist for whatever comorbid condition they have,” they wrote.

References

1. Contreras DG, Barber CEH, Aviña-Zubieta JA, et al. Avoidable hospitalizations in persons with rheumatoid arthritis: a population-based study using administrative data. Arthritis Care Res (Hoboken). Published online April 2, 2025. doi:10.1002/acr.25541
2. Canadian Institute for Health Information. Ambulatory Care Sensitive Conditions Hospitalizations. Published November 12, 2024. Accessed May 3, 2025.https://www.cihi.ca/en/indicators/ambulatory-care-sensitive-conditions-hospitalizations.
3. Kuo CF, Burns PB, Chen JS, Wang L, Chung KC. Risk of preventable hospitalization before and after diagnosis among rheumatoid arthritis patients compared to non-rheumatoid arthritis controls. Joint Bone Spine. 2020;87(2):149-156. doi:10.1016/j.jbspin.2019.11.005