Increased Mortality in Asians With Systemic Sclerosis in Northern California
Increased Mortality in Asians With Systemic Sclerosis in Northern California
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DOI：
10.1002/acr2.11126
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发表时间：
2020-04-01
影响因子：
3.4
通讯作者：
Chung, Lorinda
中科院分区：
文献类型：
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作者：
Chung, Melody P.;Dontsi, Makdine;Chung, Lorinda
本研究的目的是评估美国系统性硬化症（SSc）患者队列中疾病表现和生存率的种族/民族差异，重点是亚洲患者。方法在2007年至2016年期间，在北方加州的Kaiser Permanente成人中进行了一项回顾性队列研究，通过图表审查确认，符合2013年美国流变学学院（ACR）/欧洲反风湿联盟（EULAR）的分类标准。自我报告的人种/种族分类为非西班牙裔白色、亚裔、西班牙裔和黑人。疾病的表现和生存率进行了比较，使用白色患者作为reference.ResultsA共609例SSc事件确定：89%是女性，81%有局限性的皮肤SSc，平均年龄在55.4 - 14.8岁的诊断。人种/种族分布为51%非西班牙裔白色（n = 310）、25%西班牙裔（n = 154）、16%亚洲人（n = 96）和8%黑人（n = 49）。与白色患者相比，黑人患者弥漫性疾病的患病率更高（14.5% vs. 44.9%; P < 0.001），亚洲人抗U1-RNP抗体的发生率更高（32.1% vs. 11.9%; P = 0.005）。与白色患者（75.8%）相比，亚裔（52.3%）、黑人（52.2%）和西班牙裔患者（68.2%）在SSc诊断后的9年总生存率较低。肺动脉高压和感染是亚洲患者死亡的主要原因。亚洲人种与单变量的高死亡率相关，（风险比[HR] 1.83 [95%置信区间（CI）1.08-2.99]; P = 0.020）和多变量分析（HR 1.80 [95% CI 0.99-3.16]; P = 0.047），当调整年龄、性别、体重指数、皮肤亚型、吸烟状况、间质性肺病、肺动脉高压、肾危象时，结论：与白色患者相比，美国队列中的亚洲SSc患者死亡率增加。这些患者需要密切监测疾病进展。
ObjectiveThe objective of this study is to evaluate racial/ethnic differences in disease manifestations and survival in a US cohort of patients with systemic sclerosis (SSc), with a focus on Asian patients.MethodsA retrospective cohort study was conducted among Kaiser Permanente Northern California adults with an incident SSc diagnosis by a rheumatologist from 2007 to 2016, confirmed by a chart review to fulfill 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. Self-reported race/ethnicity was categorized as non-Hispanic white, Asian, Hispanic, and black. Disease manifestations and survival were compared, using white patients as the reference.ResultsA total of 609 patients with incident SSc were identified: 89% were women, and 81% had limited cutaneous SSc, with a mean age at diagnosis of 55.4 14.8 years. The racial/ethnic distribution was 51% non-Hispanic white (n = 310), 25% Hispanic (n = 154), 16% Asian (n = 96), and 8% black (n = 49). Compared with white patients, black patients had a greater prevalence of diffuse disease (14.5% vs. 44.9%; P < 0.001), and Asians had higher rates of anti-U1-RNP antibodies (32.1% vs. 11.9%; P = 0.005). Nine-year overall survival rates following SSc diagnosis were lower in Asian (52.3%), black (52.2%), and Hispanic patients (68.2%) compared with white patients (75.8%). Pulmonary hypertension and infections were the leading causes of death in Asian patients. Asian race was associated with higher mortality on univariable (hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.08-2.99]; P = 0.020) and multivariable analyses (HR 1.80 [95% CI 0.99-3.16]; P = 0.047) when adjusting for age, sex, body mass index, cutaneous subtype, smoking status, interstitial lung disease, pulmonary hypertension, renal crisis, and malabsorption syndrome.ConclusionAsian patients with SSc in this US cohort had increased mortality compared with white patients. These patients warrant close monitoring for disease progression.