Fibromyalgia Care Under Compounding National Crises in Lebanon: A Six-Year Longitudinal Study of Healthcare Utilization and Continuity

Background/Objectives: Fibromyalgia is a chronic, symptom-defined condition whose recognition and management depend on sustained access to care. Recorded utilization during crises may therefore reflect disrupted access, diagnostic recognition, and longitudinal engagement rather than disease burden. Since 2019, Lebanon has experienced overlapping financial deterioration, the COVID-19 pandemic, the Beirut port explosion, and armed conflict. We characterized recorded fibromyalgia utilization and continuity across these six years. Methods: This retrospective cohort study analyzed all outpatient encounters with fibromyalgia as the primary diagnosis in electronic health records of the American University of Beirut Medical Center, January 2019–December 2024. Monthly encounter volume was the primary utilization outcome. Recorded continuity was evaluated as time from each patient’s index encounter to a subsequent fibromyalgia-coded encounter, with 180-day return as the principal standardized comparison across cohorts. Results: We identified 4969 encounters from 3237 patients (87.5% female; mean age, 46.7 years). Monthly encounter volume fell around the 2019 financial and banking disruption and remained below the preceding nine-month level (84.3 vs. 66.8 encounters/month; rate ratio, 0.76; 95% CI, 0.61–0.94), with a further exploratory reduction in mid-2024. The 180-day probability of a subsequent encounter declined from 22.8% in the 2019 cohort to 15.6% in 2024 (hazard ratio, 0.59; 95% CI, 0.45–0.76); lower return rates emerged from the 2022 cohort onward. Conclusions: Recorded fibromyalgia utilization and recorded return for subsequent fibromyalgia-coded care within the same institution changed at different times during Lebanon’s compounding crises. These findings describe recorded care, not disease occurrence: recovering patient numbers may coexist with persistently lower recorded return within the institution, so aggregate utilization alone may incompletely describe recovery for continuity-dependent chronic conditions.