(19) Prevalence and Clinical Outcomes of Lipodystrophy: A US National Cohort

Publication Number: 693

Background: Limited information is available on the population-based prevalence and clinical characteristics of lipodystrophy (LD).

Objectives: To examine the annual LD prevalence between 2007 and 2019 and specific clinical outcomes in 2018-2019 among the US commercially insured population.

Methods: A cross-sectional study was conducted using the 2007-2019 Clinformatics® Data Mart, an integrated commercial healthcare claims database in the US. For each calendar year within the study, we assembled an adult LD cohort (age ≥18 years) who were continuously enrolled, allowing a 45-day gap, and had ≥1 inpatient or ≥2 outpatient LD diagnoses. The LD cohort included the subgroups: non-HIV-associated LD (non-HIV-LD) and HIV-associated LD (HIV-LD). Standardized annual LD prevalence based on the age and sex distribution of the 2019 US population was calculated. The prevalence of various clinical outcomes in 2018-2019 was estimated among the non-HIV-LD and HIV-LD subgroups. They were compared against age- and sex-matched control groups with a 1:4 ratio from the general population with neither an LD or an HIV diagnosis using odds ratios (ORs) with 95% confidence intervals.

Results: The age and sex standardized prevalence of non-HIV-LD in the general adult population slightly increased from 2.3/100,000 in 2007 to 2.9/100.000 in 2019, while the prevalence of HIV-LD stayed stable (1.9/100,000 in 2019). We identified 546 individuals with non-HIV-LD (mean age= 60.3±14.9 years, women= 67.6%) and 334 individuals with HIV-LD (mean age= 59.2±8.3 years, women= 15.0%) in 2018-2019. Compared to the general population, individuals with LD had higher risks of hyperlipidemia (OR=3.32 [2.71-4.09] among non-HIV-LD group; OR=4.36 [3.30-5.81] among HIV-LD group), hypertension (OR=3.58 [2.89-4.44]; OR=2.63 [2.02-3.42]), diabetes (OR=4.72 [3.85-5.79]; OR=1.68 [1.27-2.21]), kidney disease (OR=2.78 [2.19-3.53]; OR=3.96 [2.89-5.43]), liver fibrosis and cirrhosis (OR=4.06 [1.66-9.95]; OR=3.46 [1.39-8.46]), cancer (OR=2.20 [1.59-3.01]; OR=2.85 [1.76-4.58]), and serious infections resulting in hospitalization (OR=3.00 [2.19-4.10]; OR=2.48 [1.57-3.88]). Increased risk for autoimmune diseases (OR=3.45 [2.30-5.16]), acute pancreatitis (OR= 4.04 [1.20-13.55]), and polycystic ovary syndrome (OR=5.03 [1.08-25.44]) was identified only in individuals with non-HIV-LD.

Conclusions: LD bears a substantial burden on affected individuals due to a high prevalence of metabolic comorbidities and complications, autoimmune diseases, cancers, and serious infections resulting in hospital admissions. Future longitudinal follow-up studies are warranted to investigate the causality between LD and observed clinical outcomes.