Trends in hospitalisation, myasthenic crisis and intensive care use in myasthenia gravis: a nationwide population-based study in Spain (2016-2022).

INTRODUCTION: Myasthenia gravis (MG) is a chronic autoimmune disorder increasingly affecting older adults, with rising prevalence and comorbidity burden across Europe. Contemporary nationwide data describing MG-related hospital utilisation in European healthcare systems remain limited. We examined temporal trends and severity-related hospital outcomes in Spain between 2016 and 2022. METHODS: We conducted a retrospective, population-based analysis using the Spanish Minimum Basic Data Set, including all adult hospital episodes with a primary diagnosis of MG (ICD-10-ES G70.00, G70.01). Hospital admissions, day-hospital visits and emergency department (ED) encounters were evaluated. Variables included demographics, intensive care unit (ICU) admission, myasthenic crisis, in-hospital mortality and comorbidities. Temporal trends were analysed using segmented negative binomial regression models incorporating a breakpoint in 2018. RESULTS: A total of 20,251 MG-related episodes corresponding to 6,308 unique patients were identified. Following 2018, hospital admissions declined by 5.4% annually (95% CI − 8.4 to − 2.4), whereas day-hospital and ED utilisation increased markedly, particularly among older adults. In-hospital mortality remained low and stable (mean 2.6%). ICU admissions increased from 8.2% to 13.7% of hospitalised patients. Myasthenic crisis accounted for 4.5% of admissions and was strongly associated with ICU utilisation, representing 39% of all ICU stays. CONCLUSIONS: MG care in Spain is undergoing a sustained transition toward ambulatory management without evidence of worsening short-term hospital outcomes. Despite an ageing patient population and rising ICU utilisation, in-hospital mortality remained stable, supporting the safety of outpatient-based MG care models. These findings highlight the need for integrated clinical data to inform future healthcare planning in MG.