Rheumatoid Arthritis and Mortality Among Women During 36 Years of Prospective Follow-Up: Results From the Nurses' Health Study.
Rheumatoid Arthritis and Mortality Among Women During 36 Years of Prospective Follow-Up: Results From the Nurses' Health Study.
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DOI：
10.1002/acr.22752
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发表时间：
2016-06
影响因子：
4.7
通讯作者：
Karlson EW
中科院分区：
文献类型：
--
作者：
Sparks JA;Chang SC;Liao KP;Lu B;Fine AR;Solomon DH;Costenbader KH;Karlson EW
在护士健康研究(NHS)中前瞻性跟踪评估女性类风湿性关节炎(RA)和死亡风险。我们分析了119,209名在1976年登记时报告没有结缔组织疾病的NHS女性。通过两年一次的问卷调查收集共病和生活方式数据。类风湿性关节炎事件病例通过病历复习得到证实。通过死亡证明和病历复查确定死因。Cox回归模型估计了与未患RA的女性相比，患有RA的女性全原因、心血管疾病(CVD)、癌症和呼吸系统疾病死亡率的风险比(HR)和95%可信区间(95%CI)。在36年的前瞻性随访中，我们确认了964例类风湿关节炎病例，并确认了28,808例死亡。在307例女性类风湿关节炎患者中，80例(26%)死于癌症，70例(23%)死于心血管疾病，44例(14%)死于呼吸道原因。与未患类风湿关节炎的女性相比，患有类风湿关节炎的女性的总死亡率增加(HR 1.40，95%可信区间1.25-1.57)，与包括吸烟在内的死亡风险因素无关。RA与呼吸系统疾病死亡率(HR 2.06，95%CI 1.51~2.80)和心血管疾病死亡率(HR 1.45，95%CI 1.14~1.83)显著相关，但与癌症死亡率(HR 0.93，95%CI 0.74~1.15)无关。对于血清阳性的RA妇女，呼吸系统疾病死亡率几乎是非RA妇女的3倍(HR 2.67，95%CI 1.89-3.77)。与未患类风湿性关节炎的女性相比，患有类风湿性关节炎的女性死亡率显著增加。患有类风湿性关节炎的女性的呼吸系统疾病和心血管疾病死亡率均显著升高。仅在血清阳性RA患者中观察到呼吸系统疾病死亡率的相对风险增加近3倍。
To evaluate rheumatoid arthritis (RA) and mortality risk among women followed prospectively in the Nurses’ Health Study (NHS). We analyzed 119,209 women in the NHS who reported no connective tissue disease at enrollment in 1976. Comorbidity and lifestyle data were collected through biennial questionnaires. Incident RA cases were validated by medical records review. Cause of death was determined by death certificate and medical records review. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality for women with RA compared to those without RA. We validated 964 incident RA cases and identified 28,808 deaths during 36 years of prospective follow-up. Of 307 deaths among women with RA, 80 (26%) were from cancer, 70 (23%) were from CVD, and 44 (14%) were from respiratory causes. Women with RA had increased total mortality (HR 1.40, 95% CI 1.25–1.57) compared to those without RA, independent of mortality risk factors, including smoking. RA was associated with significantly increased respiratory disease mortality (HR 2.06, 95% CI 1.51–2.80) and cardiovascular disease mortality (HR 1.45, 95% CI 1.14–1.83), but not cancer mortality (HR 0.93, 95% CI 0.74–1.15). For women with seropositive RA, respiratory disease mortality was nearly 3-fold higher than among non-RA women (HR 2.67, 95% CI 1.89–3.77). Women with RA had significantly increased mortality compared to those without RA. Respiratory disease and cardiovascular disease mortality were both significantly elevated for women with RA. The nearly 3-fold increased relative risk of respiratory disease mortality was observed only for those with seropositive RA.