Diagnostic delay in patients from the International Map of Axial Spondyloarthritis: geographic, sociodemographic and disease-related factors.

Abstract

To assess diagnostic delay and its associated factors globally, in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS). IMAS is a cross-sectional online survey (2017-22) of 5557 axial spondyloarthritis (axSpA) patients from 27 countries. Diagnostic delay was calculated as the difference between age at diagnosis and age at first symptom onset reported by patients. Associations between diagnostic delay and regions, sociodemographic characteristics and disease-related factors were explored through univariable and multivariable linear regression analysis. Data from 5327 patients who reported data on diagnostic delay in IMAS survey were analysed: 3294 were from Europe, 752 from North America, 590 from Asia, 545 from Latin America and 146 from Africa. Overall, patients reported a mean diagnostic delay of 7.4 years (median: 4.0) since symptom onset, with substantial variation across regions; the highest delay was in South Africa and the lowest in Asia. The variables associated with longer diagnostic delay in the final multivariable regression model were: younger age at symptom onset (b = -0.100), female gender (b = 2.274), being diagnosed by a rheumatologist (b = 1.163), greater number of heathcare professionals (HCPs) seen before diagnosis (b = 1.033) and history of uveitis (b = 1.286). In this global sample of axSpA patients the mean diagnostic delay was 7.4 years, and showed significant differences across regions. Younger age at symptom onset, female gender, diagnosis made by a rheumatologist, greater number of HCPs seen before diagnosis and history of uveitis were the parameters associated with a longer diagnostic delay in axSpA patients.