Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Ninani Kombo

Abstract

The primary objective of this retrospective cross-sectional study is to investigate the national and regional incidence, epidemiology, and clinical characteristics of Giant Cell Arteritis (GCA) related hospital admissions in the United States (US) from 2007 to 2016. The secondary objectives are to investigate the rate of systemic complications, ocular involvement, resource utilization, and predictors of mortality in GCA. The Nationwide Inpatient Sample was queried to identify all patients hospitalized with an ICD 9 or ICD 10 code for GCA between 2007-2016. Incidence was calculated using US Census data, and risk factors for in-hospital mortality were analyzed with logistic regression. A weighted total of 200,533 GCA related hospital admissions were included. The overall national incidence of GCA related hospital admissions was 6.42 per 100,000 population and 19.81 per 100,000 population for those ≥50 years. The median age was 80 years. The incidence was 3 times higher in women than men (3.43 vs. 1.33 per 100,000 population) and 2 times higher in Caucasians than African Americans (7.52 vs. 3.75 per 100,000 population). The most common systemic comorbidity was hypertension (73.2%), followed by hyperlipidemia (42.0%), and diabetes mellitus (33.2%). Autoimmune disorders were common: 23% of patients had thyroid disease, 14.6% had polymyalgia rheumatica, and 5.2% had rheumatoid arthritis. 18% of GCA patients had ocular involvement, 8.6% had stroke or cerebral arteritis, and 2.87% had aortic dissection/aneurysm or myocarditis. The in-hospital mortality was 2.7%. Age >75 years (OR, 1.99; 95% CI, 1.85 – 2.13; p <0.001), stroke (OR, 1.83; 95% CI, 1.68 – 1.98; p <0.0001), and aortic compromise (OR, 1.76; 95% CI, 1.54 – 1.99; p <0.0001) were significant predictors of mortality. Notably, there was no increase in mortality in patients with ocular involvement or autoimmune disease. In the US, Giant Cell Arteritis preferentially affects older individuals, females, and Caucasians. Approximately one fifth of cases had ocular involvement during the same hospital admission. Stroke, aortic compromise, and increased age are associated with higher mortality risk.

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This is an Open Access Thesis.

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