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

J Clin Immunol. 2019 Oct;39(7):641-652. doi: 10.1007/s10875-019-00666-9. Epub 2019 Aug 1.

Abstract

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.

Keywords: CVID; PID; consultations; diagnostic delay; indicators; primary health care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aged
  • Case-Control Studies
  • Clinical Decision-Making
  • Common Variable Immunodeficiency / diagnosis*
  • Common Variable Immunodeficiency / epidemiology*
  • Comorbidity
  • Delayed Diagnosis
  • Denmark / epidemiology
  • Disease Management
  • Early Diagnosis
  • Female
  • General Practice* / methods
  • General Practice* / standards
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Population Surveillance
  • Practice Patterns, Physicians'*
  • Referral and Consultation
  • Registries
  • Young Adult