Lacaille Diane, Avina-Zubieta J Antonio, Sayre Eric C, Abrahamowicz Michal
Arthritis Research Canada, Richmond, British Columbia, Canada.
Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
Ann Rheum Dis. 2017 Jun;76(6):1057-1063. doi: 10.1136/annrheumdis-2016-209562. Epub 2016 Dec 28.
Excess mortality in rheumatoid arthritis (RA) is expected to have improved over time, due to improved treatment. Our objective was to evaluate secular 5-year mortality trends in RA relative to general population controls in incident RA cohorts diagnosed in 1996-2000 vs 2001-2006.
We conducted a population-based cohort study, using administrative health data, of all incident RA cases in British Columbia who first met RA criteria between January 1996 and December 2006, with general population controls matched 1:1 on gender, birth and index years. Cohorts were divided into earlier (RA onset 1996-2000) and later (2001-2006) cohorts. Physician visits and vital statistics data were obtained until December 2010. Follow-up was censored at 5 years to ensure equal follow-up in both cohorts. Mortality rates, mortality rate ratios and HRs for mortality (RA vs controls) using proportional hazard models adjusting for age, were calculated. Differences in mortality in RA versus controls between earlier and later incident cohorts were tested via interaction between RA status (case/control) and cohort (earlier/later).
24 914 RA cases and controls experienced 2747 and 2332 deaths, respectively. Mortality risk in RA versus controls differed across incident cohorts for all-cause, cardiovascular diseases (CVD) and cancer mortality (interactions p<0.01). A significant increase in mortality in RA versus controls was observed in earlier, but not later, cohorts (all-cause mortality adjusted HR (95% CI): 1.40 (1.30 to 1.51) and 0.97 (0.89 to 1.05), respectively).
In our population-based incident RA cohort, mortality compared with the general population improved over time. Increased mortality in the first 5 years was observed in people with RA onset before, but not after, 2000.
由于治疗的改善，类风湿关节炎（RA）的超额死亡率预计会随着时间推移而有所改善。我们的目的是评估1996 - 2000年与2001 - 2006年诊断的初发RA队列中，RA相对于一般人群对照的5年死亡率长期趋势。
我们利用行政卫生数据进行了一项基于人群的队列研究，纳入了1996年1月至2006年12月期间首次符合RA标准的不列颠哥伦比亚省所有初发RA病例，并按性别、出生年份和索引年份1:1匹配一般人群对照。队列分为早期（RA发病于1996 - 2000年）和晚期（2001 - 2006年）队列。获取医生诊疗记录和生命统计数据直至2010年12月。随访在5年时进行截尾，以确保两个队列的随访时间相等。使用调整年龄的比例风险模型计算死亡率、死亡率比和死亡率的HR（RA与对照相比）。通过RA状态（病例/对照）和队列（早期/晚期）之间的交互作用，检验早期和晚期初发队列中RA与对照的死亡率差异。
24914例RA病例和对照分别经历了2747例和2332例死亡。在所有病因、心血管疾病（CVD）和癌症死亡率方面，RA与对照的死亡风险在不同初发队列中存在差异（交互作用p<0.01）。在早期队列中观察到RA与对照相比死亡率显著增加，但在晚期队列中未观察到（全因死亡率调整HR（95%CI）：分别为1.40（1.30至1.51）和0.97（0.89至1.05））。
在我们基于人群的初发RA队列中，与一般人群相比，死亡率随时间有所改善。在2000年之前发病的RA患者中观察到前5年死亡率增加，而2000年之后发病的患者中未观察到。
