Disease crises linked to more hospital time for MG patients
Risk factors include being Hispanic or African American, early-onset disease
People with myasthenia gravis (MG) who experience exacerbations tend to require longer and more frequent hospital stays, according to a recent study.
Findings from the study, which analyzed data from a U.S. Veterans Affairs (VA) healthcare database, also suggest the risk of exacerbations is higher in people with MG who are Hispanic or African American, as well as in those with early-onset disease.
The study, “Characteristics and healthcare utilization of patients with myasthenia gravis exacerbation,” was published in the Journal of the Neurological Sciences.
Exacerbations are episodes when MG symptoms suddenly worsen. In severe cases, patients may experience a myasthenic crisis, which is a potentially life-threatening event where MG-related muscle weakness affects respiratory muscles, making it harder for a person to breathe.
Although disease exacerbations can have a profound impact on people living with MG, not everyone with MG experiences exacerbations. There isn’t much solid data on risk factors for exacerbations, or about how the use of healthcare resources differs in patients who do or don’t experience exacerbations.
Medical records of more than 10,000 MG patients analyzed
To gain greater insight into these matters, researchers analyzed the outcomes of more than 10,000 MG patients based on electronic medical records extracted from the VA healthcare database from 1999 to 2022.
Most of the patients had more than six years of follow-up data available. About three-quarters were Caucasian and nearly all were male, which was expected given that these demographics are broadly reflective of the U.S. military.
Findings showed about one-third (33.6%) of the patients experienced at least one exacerbation over the course of follow-up. Among these patients, more than half had three or more exacerbations on record, working out to a mean rate of slightly more than one exacerbation per year. These data suggest patients experiencing one exacerbation are likely going to have more in the future.
Compared with Caucasian patients, those who were African American or Hispanic had a significantly increased risk of experiencing exacerbations. The risk of exacerbation was also increased in patients who were younger at the time of diagnosis and in those who had other underlying health problems (comorbidities), such as diabetes or high blood pressure.
“Comorbidities, race/ethnicity, and time from diagnosis can all provide helpful insight into understanding the risk for MG [exacerbations],” the researchers wrote.
It’s not clear why some racial/ethnic groups have a higher risk of experiencing exacerbations. Factors such as socioeconomic inequality and higher rates of other health problems may play a role, but the team emphasized a need for more research to investigate these differences.
Exacerbations linked to more frequent, longer hospital stays
Analyses of healthcare usage data showed patients who had experienced at least one exacerbation tended to have more frequent and longer hospital stays than those who didn’t have exacerbations on record. On average, patients who had exacerbations spent nearly six days per year in the hospital, while those with no history of exacerbations spent less than two days per year in the hospital.
“Our study demonstrated that patients who have exacerbations are likely to have further exacerbations and thus a subsequent increase in [healthcare resource utilization],” the researchers wrote.
Patients with a history of exacerbations were also five times more likely to require intubation, which the researchers said is likely reflective of higher rates of myasthenic crisis among these patients. Consistently, patients with exacerbations were nearly four times as likely to spend time in intensive care units.
Overall, this study “highlights the need for improved strategies to reduce the incidence of exacerbations to help lower healthcare costs, reduce healthcare utilization, and improve patient quality of life,” the researchers wrote.
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