Temporal trends in single and multiple organ fibrosis prevalence and primary care consultations: a population-based cohort study of 5.8 million individuals in England

Abstract

Abstract Objective To understand how prevalence estimates of single and multiple organ fibrosis have changed from 2012 to 2022. Design Retrospective population-based cohort study. Setting Data from primary (Clinical Practice Research Datalink Aurum) and secondary care (Hospital Episode Statistics Admitted Patient Care) electronic health records were used to conduct this study. Participants Adults aged 18 years and older whose primary and secondary care records were available for research. Main outcome measure Fibrotic conditions previously determined from a Delphi survey of clinicians; diagnoses were found in either primary or secondary care records. The primary analysis estimated the prevalence of both single and multiple organ fibrosis. A secondary analysis used Cox proportional hazards models to investigate the association between the time-updated number of fibrotic conditions and risk of death, adjusting for age and sex. Results The cohort consisted of 5 839 459 people with at least one fibrotic condition and a denominator of 18 784 962 people. Over the study period, prevalence of fibrotic conditions increased by 6.72%, and as of 2022, 19.95% (95% CI 19.92% to 19.98%) of adults had at least one fibrotic condition. The prevalence of multiple organ fibrosis increased from 4.78% (95% CI 4.76% to 4.79%) in 2012 to 8.51% (95% CI 8.50% to 8.53%) in 2022. In the year preceding diagnosis of single organ fibrosis, the median number of primary care consultations was 14 compared with 21 consultations for people with multiple organ fibrosis. Compared with people with single organ fibrosis, people with two fibrotic conditions had a mortality HR of 2.90 (95% CI 2.87 to 2.93), while people with three fibrotic conditions had a mortality HR of 5.22 (95% CI 5.14 to 5.30). Conclusions The prevalence of single and multiple organ fibrosis has substantially increased over a decade. People with multiple organ fibrosis access healthcare more than people with single organ fibrosis and are at a greater risk of mortality. Multiple organ fibrosis is estimated to affect more than 3 million people in the UK and is increasing. Better understanding of patterns of fibrotic multimorbidity may help to aid earlier diagnosis and opportunities for reducing mortality.