Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study.
Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study.
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DOI：
10.1007/s00296-016-3638-5
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发表时间：
2017-04
影响因子：
4
通讯作者：
Dekker J
中科院分区：
文献类型：
--
作者：
van den Hoek J;Boshuizen HC;Roorda LD;Tijhuis GJ;Nurmohamed MT;van den Bos GA;Dekker J
这项研究的目的是调查(A)已确诊的类风湿性关节炎患者的临床队列中的死亡率与荷兰普通人群15年来的比较，(B)研究期间死亡率的趋势，以及(C)死亡原因并与普通人群进行比较。1997年，从一家大型风湿病门诊的登记簿上随机抽取了1222名患者。1997年至2012年他们的死亡率和主要死因是从荷兰统计局获得的。计算了全因死亡率的标准化死亡率(SMR)和研究期间损失的寿命年数，并根据年龄、性别和日历年进行了调整。采用线性泊松回归分析来评估全因SMR随时间的变化。最后，计算了特定死因死亡率的SMR。基线人群的平均年龄为60.4(SD 15.4)岁，72.6%的患者为女性。全因死亡率的估计SMR(95%可信区间)为1.54(1.41，1.67)，在研究期间损失了大约一年的生命。SMR呈下降趋势(年下降2%，p=0.07)。循环系统疾病、呼吸系统疾病、肌肉骨骼系统疾病和消化系统疾病的死亡率高于一般人群(P<0.05)。经年龄、性别和日历年调整后，类风湿关节炎患者的观察死亡率比普通人群高54%。在15年内损失了一个以上的生命年，死亡率随着时间的推移有下降的趋势。心血管疾病、呼吸系统疾病、肌肉骨骼疾病和消化系统疾病死亡率较高。
The aim of this study was to investigate (a) the mortality in a clinical cohort of patients with established rheumatoid arthritis in comparison with the general Dutch population over 15 years, (b) the trend in the mortality ratio during the study period, and (c) causes of death and compare these with the general population. In 1997, a sample of 1222 patients was randomly selected from the register of a large rheumatology outpatient clinic. Their mortality and primary causes of death between 1997 and 2012 were obtained from Statistics Netherlands. The standardized mortality ratio (SMR) for all-cause mortality and the number of life-years lost in the study period, adjusted for age, sex, and calendar year, were calculated. A linear poisson regression analysis was performed to evaluate change in all-cause SMR over time. Finally, the SMRs for cause-specific mortality were calculated. The mean age of the population at baseline was 60.4 (SD 15.4) years, and 72.6% of the patients were women. The estimated SMR (95% CI) for all-cause mortality was 1.54 (1.41, 1.67) with about one life-year lost over the study period. There was a trend to decreasing SMR (2% annually, p = .07). Mortality was higher compared with the general population for circulatory system diseases, respiratory system diseases, musculoskeletal system diseases, and digestive system diseases (p < .05). The observed mortality among patients with RA was 54% higher than in the general population after adjustment for age, sex and calendar year. More than one life-year was lost over 15 years, and the mortality tended to decrease over time. The mortality was higher for cardiovascular, respiratory, musculoskeletal and digestive diseases.