Doran Michele F, Pond Gregory R, Crowson Cynthia S, O'Fallon W Michael, Gabriel Sherine E
Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis Rheum. 2002 Mar;46(3):625-31. doi: 10.1002/art.509.
To determine time trends in the epidemiology of rheumatoid arthritis (RA) in a population-based cohort.
An inception cohort of residents of Rochester, Minnesota > or = 18 years of age who first fulfilled the American College of Rheumatology 1987 criteria between January 1, 1955 and December 31, 1994 (applied retrospectively, as appropriate) was assembled and followed up until January 1, 2000. Incidence rates were estimated and were age- and sex-adjusted to the 1990 white population of the US. A birth cohort analysis was performed, and survival rates over time were examined.
The incidence cohort comprised 609 patients, 445 (73.1%) of whom were female and 164 (26.9%) were male, with a mean age at incidence of 58.0 years. The overall age- and sex-adjusted annual incidence of RA among Rochester, Minnesota, residents > or = 18 years of age was 44.6/100,000 population (95% confidence interval 41.0-48.2). While the incidence rate fell progressively over the 4 decades of study, from 61.2/100,000 in 1955-1964, to 32.7/100,000 in 1985-1994, there were indications of cyclical trends over time. Birth cohort analysis showed diminishing incidence rates through successive cohorts following a peak in the 1880-1890 cohorts. Incidence rates increased with age until age 85, but peaked earlier in women than in men. The survival rate in RA patients was significantly lower than the expected rate in the general population (P < 0.001), and no improvement was noted over time.
The secular trends demonstrated in this study population, including the progressive decline in the incidence of RA over the last 40 years, suggest that an environmental factor may play a role in the etiology of RA.
确定以人群为基础的队列中类风湿关节炎（RA）的流行病学时间趋势。
收集明尼苏达州罗切斯特市年龄≥18岁的居民起始队列，这些居民在1955年1月1日至1994年12月31日期间首次符合美国风湿病学会1987年标准（必要时进行回顾性应用），并随访至2000年1月1日。估计发病率，并根据1990年美国白人人口进行年龄和性别调整。进行出生队列分析，并检查随时间的生存率。
发病队列包括609例患者，其中445例（73.1%）为女性，164例（26.9%）为男性，发病时的平均年龄为58.0岁。明尼苏达州罗切斯特市年龄≥18岁居民中，经年龄和性别调整后的RA总体年发病率为44.6/10万人口（95%置信区间41.0 - 48.2）。虽然在40年的研究期间发病率逐渐下降，从1955 - 1964年的61.2/10万降至1985 - 1994年的32.7/10万，但有迹象表明随时间存在周期性趋势。出生队列分析显示，在1880 - 1890年队列达到峰值后，连续队列的发病率逐渐降低。发病率随年龄增长直至85岁，但女性比男性更早达到峰值。RA患者的生存率显著低于一般人群的预期生存率（P < 0.001），且随时间未观察到改善。
本研究人群中显示的长期趋势，包括过去40年中RA发病率的逐渐下降，提示环境因素可能在RA的病因中起作用。
