Survival in rheumatoid arthritis - A population-based analysis of trends over 40 years
Survival in rheumatoid arthritis - A population-based analysis of trends over 40 years
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DOI：
10.1002/art.10705
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发表时间：
2003-01-01
影响因子：
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通讯作者：
Matteson, EL
中科院分区：
文献类型：
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作者：
Gabriel, SE;Crowson, CS;Matteson, EL
目标。评估类风湿性关节炎(RA)患者40年来的死亡率趋势和危险因素。从所有年龄大于或等于18岁的明尼苏达州罗切斯特居民中收集了一个以人群为基础的初始队列，这些居民在1955年1月1日至1994年12月31日期间首次被诊断为类风湿性关节炎(符合1987年美国风湿病学会的类风湿性关节炎标准)。患者通过他们的整个医疗记录(包括任何提供者提供的所有住院和门诊护理)进行纵向跟踪，直到死亡或从该县移民。生存采用Kaplan-Meier方法描述。观察生存期和预期生存期的比较使用对数等级检验，预期生存期的标准化死亡率(SMR)是基于研究人群的性别和年龄以及明尼苏达州寿命表中的死亡率。在控制了年龄、性别、体重指数(BMI)、吸烟和类风湿因子阳性的情况下，使用COX比例风险模型估计关节外表现和合并症的影响。在整个时间段内，RA队列中的存活率显著低于人群中的预期存活率(P<；0.001)。类风湿关节炎患者的死亡风险显著更高，SMR为1.27(95%可信区间为1.13-1.41)。女性的超额死亡率比男性更明显，SMR分别为1.41和1.08。在调整了年龄、性别、体重指数、吸烟和类风湿因子阳性后，关节外表现是死亡率的最强预测因子。RA患者的存活率明显低于预期。存活的最强预测因素似乎是那些与RA疾病并发症相关的因素，特别是疾病的关节外表现和合并症。应更多地关注死亡率作为类风湿性关节炎的预后指标。
Objective. To evaluate trends in and risk factors for mortality among patients with rheumatoid arthritis (RA) over a 40-year period.Methods. A population-based inception cohort was assembled from among all Rochester, Minnesota residents ages greater than or equal to18 years who were first diagnosed with RA (fulfilling the 1987 American College of Rheumatology criteria for RA) between January 1, 1 955 and December 31, 1994. Patients were followed up longitudinally through their entire medical records (including all inpatient and outpatient care by any provider) until death or migration from the county. Survival was described using the Kaplan-Meier method. Observed and expected survival were compared using the log-rank test, and standardized mortality ratios (SMRs) with expected survival were based on the sex and age of the study population and death rates from the Minnesota life tables. Cox proportional hazards models were used to estimate the influence of extraarticular manifestations and comorbidities, controlling for age, sex, body mass index (BMI), smoking, and rheumatoid factor positivity.Results. Survival in this RA cohort was significantly lower than that expected in the population (P < 0.001) over the entire time period. Patients with RA were at significantly higher risk of death, with an SMR of 1.27 (95% confidence interval 1.13-1.41). Excess mortality among women was more pronounced than among men, with SMRs of 1.41 and 1.08, respectively. Presence of A extraarticular manifestation was the strongest predictor of mortality after adjusting for age, sex, BMI, smoking, and rheumatoid factor positivity.Conclusion. Survival in RA patients is significantly lower than expected. The strongest predictors of survival appear to be those related to RA disease complications, specifically, extraarticular manifestations of the disease and comorbidities. More attention should be paid to mortality as an outcome measure in RA.