Objectives IgG4-related disease (IgG4-RD) can affect nearly any organ and is often treated with glucocorticoids, which contribute to organ damage and toxicity. Comorbidities and healthcare utilization in IgG4-RD are poorly understood. Methods We conducted a cohort study using claims data from a United States managed care organization. Incident IgG4-RD cases were identified using a validated algorithm; general population comparators were matched by age, sex, race/ethnicity, and index date. The frequency of 21 expert-defined clinical outcomes associated with IgG4-RD or its treatment and healthcare-associated visits and costs were assessed 12 months before and 36 months after the index date (date of earliest IgG4-RD-related claim). Results There were 524 cases and 5,240 comparators. Most cases received glucocorticoids prior to (64.0%) and after (85.1%) the index date. Nearly all outcomes, many being common glucocorticoid toxicities, occurred more frequently in cases vs comparators. During follow-up, the largest differences between cases and comparators were seen for gastroesophageal reflux disease (prevalence difference: +31.2%, p< 0.001); infections (+17.3%, p< 0.001); hypertension (+15.5%, p< 0.01); and diabetes mellitus (+15.0%, p< 0.001). The difference in malignancy increased during follow-up from +8.8% to + 12.5% (p< 0.001). 17.4% of cases used pancreatic enzyme replacement therapy during follow-up. Over follow-up, cases were more often hospitalized (57.3% vs 17.2%, p< 0.01) and/or had an ER visit (72.0% vs 36.7%, p< 0.01); all costs were greater in cases than comparators. Conclusions Patients with IgG4-RD are disproportionately affected by adverse outcomes, some of which may be preventable or modifiable with vigilant clinician monitoring. Glucocorticoid-sparing treatments may improve these outcomes.

中文翻译：

---

IgG4 相关疾病的临床结果和医疗资源利用：对美国商业保险成年人的基于索赔的分析

目标 IgG4 相关疾病 (IgG4-RD) 几乎可以影响任何器官，通常用糖皮质激素治疗，但会导致器官损伤和毒性。人们对 IgG4-RD 的合并症和医疗保健利用知之甚少。方法 我们使用美国管理式医疗组织的索赔数据进行了一项队列研究。使用经过验证的算法识别事件 IgG4-RD 病例；一般人群比较者按年龄、性别、种族/族裔和索引日期进行匹配。在索引日期（最早的 IgG4-RD 相关索赔日期）之前 12 个月和之后 36 个月评估了与 IgG4-RD 相关的 21 项专家定义的临床结果或其治疗和医疗保健相关就诊和费用的频率。结果 纳入病例524例，对照者5240例。大多数病例在索引日期之前 (64.0%) 和之后 (85.1%) 接受糖皮质激素治疗。与对照组相比，几乎所有结果（其中许多是常见的糖皮质激素毒性）在病例中发生的频率更高。在随访期间，病例和对照者之间最大的差异是胃食管反流病（患病率差异：+31.2%，p<0.001）；感染（+17.3%，p<0.001）；高血压（+15.5%，p＜0.01）；和糖尿病(+15.0%，p＜0.001)。随访期间恶性肿瘤的差异从+8.8%增加到+12.5%(p＜0.001)。 17.4%的病例在随访期间使用胰酶替代疗法。随访期间，病例更常住院（57.3% vs 17.2%，p < 0.01）和/或进行急诊室就诊（72.0% vs 36.7%，p < 0.01）；案例中的所有成本都高于比较案例。结论 IgG4-RD 患者受到不良后果的影响尤为严重，其中一些不良后果是可以通过临床医生的警惕监测来预防或改变的。糖皮质激素节约治疗可能会改善这些结果。