Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period
Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period
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DOI：
10.1002/art.509
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发表时间：
2002-03-01
影响因子：
--
通讯作者：
Gabriel, SE
中科院分区：
文献类型：
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作者：
Doran, MF;Pond, GR;Gabriel, SE
目标。在人群为基础的队列中确定类风湿关节炎（RA）流行病学的时间趋势。在1955年1月1日至1994年12月31日期间，明尼苏达州罗彻斯特市年龄大于或等于18岁的居民首次符合美国风湿病学会1987年的标准（酌情追溯适用），并进行了随访，直到2000年1月1日。对发病率进行了估计，并根据1990年美国白人的年龄和性别进行了调整。进行了出生队列分析，并检查了随时间推移的存活率。发病队列包括609例患者，其中女性445例（73.1%），男性164例（26.9%），平均发病年龄58.0岁。明尼苏达州罗彻斯特市18岁以上居民经年龄和性别调整后的RA年总发病率为44.6/10万人（95%可信区间41.0-48.2）。虽然发病率在40年的研究中逐渐下降，从1955-1964年的61.2/10万下降到1985-1994年的32.7/10万，但有迹象表明，随着时间的推移出现了周期性趋势。出生队列分析显示，在1880-1890年队列达到峰值后，连续队列的发病率逐渐下降。发病率随着年龄的增长而增加，直到85岁，但女性比男性更早达到顶峰。RA患者的生存率明显低于一般人群的预期生存率（P < 0.001），并且随着时间的推移没有改善。在本研究人群中显示的长期趋势，包括过去40年来RA发病率的逐渐下降，表明环境因素可能在RA的病因中起作用。
Objective. To determine time trends in the epidemiology of rheumatoid arthritis (RA) in a population-based cohort.Methods. An inception cohort of residents of Rochester, Minnesota greater than or equal to18 years of age who first fulfilled the American College of Rheumatology 1987 criteria between January 1, 1955 and December 31, 1994 (applied retrospectively, as appropriate) was assembled and followed up until January 1, 2000. Incidence rates were estimated and were age- and sex-adjusted to the 1990 white population of the US. A birth cohort analysis was performed, and survival rates over time were examined.Results. The incidence cohort comprised 609 patients, 445 (73.1%) of whom were female and 164 (26.9%) were male, with a mean age at incidence of 58.0 years. The overall age- and sex-adjusted annual incidence of RA among Rochester, Minnesota, residents greater than or equal to18 years of age was 44.6/100,000 population (95% confidence interval 41.0-48.2). While the incidence rate fell progressively over the 4 decades of study, from 61.2/100,000 in 1955-1964, to 32.7/100,000 in 1985-1994, there were indications of cyclical trends over time. Birth cohort analysis showed diminishing incidence rates through successive cohorts following a peak in the 1880-1890 cohorts. Incidence rates increased with age until age 85, but peaked earlier in women than in men. The survival rate in RA patients was significantly lower than the expected rate in the general population (P < 0.001), and no improvement was noted over time.Conclusion. The secular trends demonstrated in this study population, including the progressive decline in the incidence of RA over the last 40 years, suggest that an environmental factor may play a role in the etiology of RA.