Medical care and treatment of allergic rhinitis: a population-based cohort study based on routine healthcare utilization data

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Abstract

Background:

Health services research on medical care and treatment of allergic rhinitis (AR) is scarce.

Objectives:

To investigate the prevalence, incidence, comorbidities, and treatment of AR in a realistic setting.

Methods:

A cohort of 1 811 094 German National Health Insurance beneficiaries in 2005 was followed until 2011. To avoid misclassification, the ICD-10 code for AR (J30) had to be documented at least twice to classify patients as having AR. Descriptive statistics and logistic regression models were used to describe the burden, comorbidities, and treatment of AR.

Results:

A total of 111 394 patients (6.2%) had prevalent AR in 2005/2006. In another 60 145 individuals (3.3%), AR was newly diagnosed in 2007 to 2011 (incident cases). Patients with prevalent AR were three times more likely to develop asthma compared to patients without AR (age and sex-adjusted risk ratio (RR) 3.04; 95% confidence interval (95%CI) 2.98–3.10). Newly diagnosed recurrent depressive disorder (RR 1.61; 95%CI 1.55–1.68), anxiety disorder (RR 1.52; 95%CI 1.48–1.56), and ADHD (RR 1.21; 95%CI 1.13–1.29) were also related to prevalent AR. Approximately 20% of children and 36% of adults with AR were exclusively treated by general practitioners. Allergy immunotherapy (AIT) was prescribed for 16.4% of patients with AR. Subcutaneous immunotherapy was most frequently used (80% of AIT).

Conclusions:

This study highlights the significant burden of AR. Despite the established benefits of AIT to treat AR and prevent asthma, this study suggests significant undertreatment. Future research is necessary to develop and implement adequate measures to increase guideline adherence.

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