Comorbidities, Health-Related Quality of Life, Health-care Utilization in Older Persons with Hemophilia—Hematology Utilization Group Study Part VII (HUGS VII)

• Type of Material: Article
• Authors: Duc Tran Jr, Emory University; Randall Curtis, Factor VIII Computing; Marilyn Manco-Johnson, University of Colorado Anschutz Medical Campus; Barbara A Konkle, University of Washington; Roshni Kulkarni, MSU College of Human Medicine; Joanne Wu, University of Southern California; Judith R Baker, Center for Comprehensive Care and Diagnosis of Inherited Bleeding Disorders; Megan Ullman, University of Texas Health Science Center at Houston; Duc Quang Tran, Emory University School of Medicine; Michael B Nichol, University of Southern California
• Language: English
• Date: 2022-01-01
• Publisher: Dove Press Ltd
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Curtis et al.
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2147/JBM.S354526
• Title of Journal or Parent Work: Journal of Blood Medicine
• Volume: 13
• Start Page: 229
• End Page: 241
• Grant/Funding Information: The study was supported by Pfizer through an Investigator-Initiated Research agreement between Pfizer and the University of Southern California (USC).
• Keywords: burden of hemophilia; aging in hemophilia; hemophilia B; hemophilia A
• Research Categories: Health Sciences, Oncology

Abstract

Purpose: We compare the impact of hemophilia on comorbidities, joint problems, health-related quality of life (HRQoL) and healthcare utilization between two age groups: 40–49 years and ≥50 years. Patients and Methods: The HUGS VII study recruited persons with hemophilia A or B age ≥40 years. Participants completed surveys to collect data on sociodemographic and clinical characteristics, hemophilia treatment regimen, pain, joint problems, comorbidities, HRQoL, depression and anxiety, at baseline and 6-months later. Clinical chart reviews documented hemophilic severity and treatment. Results: The sample includes 69 males, 65.2% aged ≥50 years, 75.4% with hemophilia A. Individuals ≥50 years were more likely to have mild or moderate hemophilia (68.9% vs 41.7%, P = 0.03) than those 40–49 years old. Among persons with mild/moderate hemophilia, those ≥50 years old reported a higher rate of joint pain (83.9% vs 70.0%, P = 0.34 at baseline, 91.3% vs 57.1%, P = 0.06 at follow up) or range of motion limitation (73.3% vs 60.0%, P = 0.43 at baseline, 73.9% vs 28.6%, P = 0.04 at follow up) than the younger group. Compared to the younger group, the older group reported fewer emergency room visits (4.5% vs 21.7%, P = 0.03), and physical therapy visits (15.9% vs 43.5%, P = 0.01) at baseline. The sample depression rate was 85.7%, but the differences among the age groups were not significant. The mean covariate-adjusted EQ-5D index score was lower in older persons (0.77 vs 0.89, P = 0.02). Conclusion: Older persons with hemophilia in this sample are over-represented by individuals with mild/moderate disease, potentially due to premature death among those with severe disease. Although this group included a larger proportion of individuals with mild disease than the younger group, they experienced lower quality of life, more comorbidities both of aging and of hemophilic arthropathy, and lower rates of health-care utilization.