How to Identify Common Variable Immunodeficiency Patients Earlier: General Practice Patterns

Purpose Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with th...

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Bibliographic Details
Published in:Journal of clinical immunology Vol. 39; no. 7; pp. 641 - 652
Main Authors: Ilkjær, Frederik V., Rasmussen, Line D., Martin-Iguacel, Raquel, Westh, Lena, Katzenstein, Terese L., Hansen, Ann-Brit E., Nielsen, Thyge L., Larsen, Carsten S., Johansen, Isik S.
Format: Journal Article
Language:English
Published: New York Springer US 01.10.2019
Springer Nature B.V
Subjects:
Adolescent
Adult
Age of Onset
Aged
Biomedical and Life Sciences
Biomedicine
Case-Control Studies
Clinical Decision-Making
Common variable immunodeficiency
Common Variable Immunodeficiency - diagnosis
Common Variable Immunodeficiency - epidemiology
Comorbidity
Delayed Diagnosis
Denmark - epidemiology
Differential diagnosis
Disease Management
Early Diagnosis
Female
General Practice - methods
General Practice - standards
Humans
Immunology
Infectious Diseases
Internal Medicine
Male
Medical Microbiology
Middle Aged
Odds Ratio
Original Article
Population Surveillance
Practice Patterns, Physicians
Referral and Consultation
Registries
Respiratory function
Statistical analysis
Young Adult
Denmark
CVID
primary health care
PID
diagnostic delay
indicators
consultations
ISSN:0271-9142, 1573-2592, 1573-2592
Online Access:Get full text
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Summary:Purpose Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3 years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations. Methods We conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997–2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). Results The median number of consultations among individuals with CVID was more than twice that of the controls in all 3 years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40 years. In the 3rd year before diagnosis, having 9–15 consultations compared with 1–4 was associated with an OR (95%CI) of 5.0 (2.3–10.9), 2.4 (1.1–5.4), and 1.3 (0.3–5.3) for those aged 18–40, 41–60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis. Conclusion The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40 years old.
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ISSN:0271-9142
1573-2592
1573-2592
DOI:10.1007/s10875-019-00666-9