A Population-Based Cohort Study on Chronic Comorbidity Risk Factors for Adverse Dengue Outcomes

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  • 1 Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, Taipei, Taiwan;
  • | 2 Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;
  • | 3 Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan;
  • | 4 Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan;
  • | 5 Takeda Vaccines, Cambridge, Massachusetts

The global burden of dengue is increasing against a background of rising global prevalence of chronic noncommunicable diseases (NCDs) and an epidemiological shift of dengue toward older age groups. The contribution of NCDs toward risk for adverse clinical and healthcare utilization outcomes was assessed in a national linked-database study. About 51,433 adult dengue cases between 2014 and 2015 were assessed for outpatient and inpatient claims data in Taiwan’s National Health Insurance Research Database for the 30 days after their dengue diagnosis. A multivariable logistic regression with generalized estimating equations was used to estimate the probability of adverse dengue outcomes in patients with NCDs compared with dengue patients without underlying diseases. Rheumatoid arthritis and related disease were associated with the highest risk of hospitalization after dengue diagnosis (odds ratio: 1.78; 95% CI: 1.37–2.30), followed by stroke, chronic kidney disease (CKD), liver cirrhosis, asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, congestive heart failure, hypertension, and malignancy. Chronic kidney disease and diabetes were associated with higher risks of hospitalization, intensive care unit (ICU) use, and all-cause mortality. After adjusting for socioeconomic status and other variables, the number of coexisting chronic diseases was associated with increasing risk of adverse dengue outcomes. Specific NCDs were associated with longer hospitalizations, ICU admission, and higher healthcare costs. Quantifying the risks of adverse dengue outcomes and health expenditures among dengue patients with preexisting NCDs provides insights for improved clinical management and essential inputs for health economic analyses on the cost-benefit of risk-based routine or catch-up immunization programs.

Author Notes

Address correspondence to Theodore Tsai, Takeda Vaccines, 75 Sidney St., Cambridge, MA 02139, E-mail: ted.tsai@takeda.com or Nicole Huang, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No.155, Section 2, Li-Nong Street, Taipei 112, Taiwan, Republic of China, E-mail: syhuang@nycu.edu.tw.

Financial support: This study was sponsored by Takeda Vaccines, Inc.

Disclaimer: C.-E. L., Y.-J. S., Y.-J. C., and N. H received the research grant from Takeda Vaccines. T. T. reports personal fees as an employee of Takeda Vaccines (Cambridge, MA) during the conduct of the study.

Authors’ addresses: Chia-En Lien, Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, Taipei, Taiwan, E-mail: allenlientw@gmail.com. Yiing-Jenq Chou, Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, and Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan, E-mail: yjchou@nycu.edu.tw. Yi-Jung Shen and Nicole Huang, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, E-mails: yijungshen@gmail.com and syhuang@nycu.edu.tw. Theodore Tsai, Takeda Vaccines, Cambridge, MA, E-mail: ted.tsai@takeda.com.

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