Calvo-Alén J, Alarcón G S, Campbell R, Fernández M, Reveille J D, Cooper G S
The University of Alabama at Birmingham, 35294-3408, USA.
Rheumatology (Oxford). 2005 Sep;44(9):1186-9. doi: 10.1093/rheumatology/keh717. Epub 2005 Jun 14.
To determine to what extent the diagnosis of systemic lupus erythematosus (SLE) in deceased lupus patients is under-reported in death certificates, and the patient characteristics associated with such an occurrence.
The death certificates of 76 of the 81 deceased SLE patients from two US lupus cohorts (LUMINA for Lupus in Minorities: Nature vs Nurture and CLU for Carolina Lupus Study), including 570 and 265 patients, respectively, were obtained from the Offices of Vital Statistics of the states where the patients died (Alabama, Georgia, North Carolina, South Carolina, Tennessee and Texas). Both cohorts included patients with SLE as per the American College of Rheumatology criteria, aged > or =16 yr, and disease duration at enrolment of < or =5 yr. The median duration of follow-up in each cohort at the time of these analyses ranged from 38.1 to 53.0 months. Standard univariable analyses were performed comparing patients with SLE recorded anywhere in the death certificate and those without it. A multivariable logistic regression model was performed to identify the variables independently associated with not recording SLE in death certificates.
In 30 (40%) death certificates, SLE was not recorded anywhere in the death certificate. In univariable analyses, older age was associated with lack of recording of SLE in death certificates [mean age (standard deviation) 50.9 (15.6) years and 39.1 (18.6) yr among those for whom SLE was omitted and included on the death certificates, respectively, P = 0.005]. Patients without health insurance, those dying of a cardiovascular event and those of Caucasian ethnicity were also more likely to be in the non-recorded group. In the multivariable analysis, variables independently associated with not recording SLE as cause of death were older age [odds ratio = (95% confidence interval) 1.043 (1.005-1.083 per yr increase); P = 0.023] and lack of health insurance [4.649 (1.152-18.768); P = 0.031].
A high proportion of SLE diagnoses are not recorded in death certificates. Older patients and those without health insurance are more prone to have SLE not recorded. These findings do have implications for the assessment of the impact of this disease in epidemiological studies conducted using vital statistics records.
确定死亡的狼疮患者中系统性红斑狼疮(SLE)的诊断在死亡证明书中漏报的程度,以及与此种情况相关的患者特征。
从美国两个狼疮队列(少数民族狼疮:先天与后天因素研究中的LUMINA队列和卡罗来纳狼疮研究中的CLU队列)的81例死亡的SLE患者中获取76例患者的死亡证明书,这两个队列分别包含570例和265例患者;患者死亡证明书中的信息来自其死亡所在州(阿拉巴马州、佐治亚州、北卡罗来纳州、南卡罗来纳州、田纳西州和得克萨斯州)的生命统计办公室。两个队列均纳入符合美国风湿病学会标准、年龄≥16岁且入组时病程≤5年的SLE患者;在进行这些分析时,每个队列的中位随访时间为38.1至53.0个月。进行标准单变量分析以比较在死亡证明书中任何位置记录有SLE的患者和未记录的患者。进行多变量逻辑回归模型以确定与未在死亡证明书中记录SLE独立相关的变量。
在30份(40%)死亡证明书中,SLE在死亡证明书上任何位置均未记录。在单变量分析中,年龄较大与死亡证明书中未记录SLE相关[在死亡证明书中SLE被遗漏和记录者的平均年龄(标准差)分别为50.9(15.6)岁和39.1(18.6)岁,P =0.005]。没有医疗保险、死于心血管事件以及白人种族的患者也更有可能属于未记录组。在多变量分析中与未将SLE记录为死亡原因独立相关的变量为年龄较大[比值比=(95%置信区间)1.043(每年增加1.005 - 1.083);P =0.023]和没有医疗保险[4.649(1.152 - 18.768);P =0.031]。
死亡证明书中未记录很大比例的SLE诊断。年龄较大的患者和没有医疗保险的患者更易出现SLE未被记录的情况。这些发现对于使用生命统计记录进行的流行病学研究中评估该疾病的影响具有重要意义。