Mortality Outcomes in Pediatric Rheumatology in the US
Mortality Outcomes in Pediatric Rheumatology in the US
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DOI：
10.1002/art.27218
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发表时间：
2010-02-01
影响因子：
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通讯作者：
Bowyer, Suzanne L.
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文献类型：
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作者：
Hashkes, Philip J.;Wright, Bridget M.;Bowyer, Suzanne L.
目标。描述美国儿童风湿性疾病的死亡率、死亡原因和潜在的死亡危险因素。我们使用了印第安纳波利斯儿童风湿病注册中心，其中包括来自62个中心的49,023名患者，他们是在1992至2001年间新诊断的。识别符与2005年3月审查的社会保障死亡指数相匹配。死亡由死亡证明、推荐的医生和医疗记录确认。死因是通过查阅图表或根据死亡证明得出的。确定标准化死亡率(SMR)和95%可信区间(95%CI)。排除恶性肿瘤患者后，48,885名患者中有110人死亡(0.23%)。患者获得平均+/-SD7.9+/-2.7年的随访。整个队列的SMR显著降低(0.65[95%可信区间0.53-0.78])，随访患者的差异>；=9年。系统性红斑狼疮(3.06[95%CI 1.78~4.90])和皮肌炎(2.64[95%CI 0.86~6.17])的SMR显著大于系统性幼年类风湿关节炎(1.8[95%CI 0.66~3.92])。痛证SMR显著降低(0.41[95%CI 0.21~0.72])。死亡原因与风湿诊断(含并发症)有关39例(35%)，治疗并发症11例(10%)，非自然原因25例(23%)，背景疾病23例(21%)，不明原因12例(11%)。风湿性疾病的诊断、确诊时的年龄、性别、早期使用全身类固醇和甲氨蝶呤与死亡风险显著相关。我们的研究结果表明，儿童风湿性疾病的总体死亡率没有增加。即使是与死亡率增加相关的疾病和状况，死亡率也明显低于之前的研究报告。
Objective. To describe mortality rates, causes of death, and potential mortality risk factors in pediatric rheumatic diseases in the US.Methods. We used the Indianapolis Pediatric Rheumatology Disease Registry, which includes 49,023 patients from 62 centers who were newly diagnosed between 1992 and 2001. Identifiers were matched with the Social Security Death Index censored for March 2005. Deaths were confirmed by death certificates, referring physicians, and medical records. Causes of death were derived by chart review or from the death certificate. Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were determined.Results. After excluding patients with malignancy, 110 deaths among 48,885 patients (0.23%) were confirmed. Patients had been followed up for a mean +/- SD of 7.9 +/- 2.7 years. The SMR of the entire cohort was significantly decreased (0.65 [95% CI 0.53-0.78]), with differences in patients followed up for >= 9 years. The SMR was significantly greater for systemic lupus erythematosus (3.06 [95% CI 1.78-4.90]) and dermatomyositis (2.64 [95% CI 0.86-6.17]) but not for systemic juvenile rheumatoid arthritis (1.8 [95% CI 0.66-3.92]). The SMR was significantly decreased in pain syndromes (0.41 [95% CI 0.21-0.72]). Causes of death were related to the rheumatic diagnosis (including complications) in 39 patients (35%), treatment complications in 11 (10%), non-natural causes in 25 (23%), background disease in 23 (21%), and were unknown in 12 patients (11%). Rheumatic diagnoses, age at diagnosis, sex, and early use of systemic steroids and methotrexate were significantly associated with the risk of death.Conclusion. Our findings indicate that the overall mortality rate for pediatric rheumatic diseases was not increased. Even for the diseases and conditions associated with increased mortality, mortality rates were significantly lower than those reported in previous studies.