Unchanging premature mortality trends in systemic lupus erythematosus: a general population-based study (1999-2014)
Unchanging premature mortality trends in systemic lupus erythematosus: a general population-based study (1999-2014)
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DOI：
10.1093/rheumatology/kex412
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发表时间：
2018-02-01
期刊：
影响因子：
5.5
通讯作者：
Choi, Hyon K.
中科院分区：
文献类型：
--
作者：
Jorge, April M.;Lu, Na;Choi, Hyon K.
目标。SLE患者的发病率和过早死亡率增加。这种死亡率差距是否在最近几年有所改善，如类风湿关节炎，尚不清楚。我们使用一个代表英国普通人群的医疗记录数据库进行了一项基于人群的队列研究。我们确定了1999年至2014年间发生的SLE病例和匹配的非SLE对照，根据SLE诊断年份分为两个亚组，形成早期队列（1999-2006）和晚期队列（2007-14）。我们比较了死亡率和风险比，调整了潜在的混杂因素。我们分别在早期和晚期队列中确定了1470例和1666例SLE病例。在这两个队列中，SLE患者的超额死亡率水平与匹配的比较组相似[早期队列中15.9 vs 7.9死亡/1000人年（PY），晚期队列中13.8 vs 7.0死亡/1000人年]。在早期和晚期队列中，相应的死亡率风险比分别为2.15 （95% CI 1.63, 2.83）和2.12 (95% CI 1.61, 2.80)（相互作用的p值= 0.95）。绝对死亡率差异分别为8.0 （95% CI 4.3, 11.8）和6.8 （95% CI 3.5, 10.0）例死亡/1000 PY（相互作用p值= 0.61）。这项基于一般人群的队列研究表明，近年来SLE患者的超额死亡率没有改善，与同期的RA不同，SLE患者的超额死亡率仍然是比较组的两倍以上。这突出了开发新的治疗药物和改进SLE及其合并症的管理策略的关键未满足需求。
Objective. Patients with SLE have increased morbidity and premature mortality. Whether this mortality gap has improved in recent years, as in RA, is unknown.Methods. We conducted a population-based cohort study using a medical records database representative of the general population of the UK. We identified incident SLE cases and matched non-SLE controls between 1999 and 2014, divided into two subgroups based on year of SLE diagnosis, forming the early cohort (1999-2006) and late cohort (2007-14). We compared the mortality rates and hazard ratios, adjusting for potential confounders.Results. We identified 1470 and 1666 incident SLE cases in the early and late cohorts, respectively. In both cohorts, SLE patients had similar levels of excess mortality compared with their matched comparators [15.9 vs 7.9 deaths/1000 person-years (PY) in the early cohort and 13.8 vs 7.0 deaths/1000 PY in the late cohort]. The corresponding mortality hazard ratios were 2.15 (95% CI 1.63, 2.83) and 2.12 (95% CI 1.61, 2.80) in the early and late cohorts, respectively (P-value for interaction = 0.95). The absolute mortality differences were 8.0 (95% CI 4.3, 11.8) and 6.8 (95% CI 3.5, 10.0) deaths/1000 PY, respectively (P-value for interaction = 0.61).Conclusion. This general population-based cohort study suggests that excess mortality has not improved among SLE patients in recent years, remaining greater than double that of comparators, unlike RA during the same period. This highlights a critical unmet need for the development of new therapeutic agents and improved management strategies for SLE and its comorbidities.