Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Semin Arthritis Rheum. 2018 Feb;47(4):586-592. doi: 10.1016/j.semarthrit.2017.07.009. Epub 2017 Jul 25.
Indigenous populations of Canada, America, Australia, and New Zealand have increased rates and severity of rheumatic disease. Our objective was to summarize mortality outcomes and explore disease and social factors related to mortality.
A systematic search was performed in medical (Medline, EMBASE, and CINAHL), Indigenous and conference abstract databases (to June 2015) combining search terms for Indigenous populations and rheumatic diseases. Studies were included if they reported measures of mortality (crude frequency, mortality rate, survival, and potential years of life lost (PYLL)) in Indigenous populations from the four countries.
Of 5269 titles and abstracts identified, 504 underwent full-text review and 12 were included. No studies from New Zealand were found. In five Canadian studies of systemic lupus erythematosus (SLE) patients, First Nations ethnicity was associated with lower survival after adjusting for disease and social factors, and an increased frequency of death from lupus and its complications compared to Caucasians was found. All-cause mortality was higher in Native Americans (n = 2 studies) relative to Whites with SLE after adjusting for disease and social factors, but not in those with lupus nephritis alone. Australian Aborigines with SLE frequently developed infection and lupus complications leading to death (n = 3 studies). Mortality rates were increased in Pima Indians in the United States with rheumatoid arthritis (RA) compared to those without RA. One study in Native Americans with scleroderma found nearly all deaths were related to progressive disease.
Canadian and American Indigenous populations with SLE have increased mortality rates compared to Caucasian populations. Mortality in Canadian and Australian Indigenous populations with SLE, and in Native American populations with RA and scleroderma, is frequently attributed to disease progression or complications. The proportional attribution of rheumatic disease severity and social factors to mortality and complications leading to death between Indigenous and non-Indigenous populations has not been fully evaluated.
加拿大、美国、澳大利亚和新西兰的原住民人群风湿性疾病的发病率和严重程度更高。我们的目的是总结死亡率结果，并探讨与死亡率相关的疾病和社会因素。
系统检索了医学（Medline、EMBASE 和 CINAHL）、原住民和会议摘要数据库（截至 2015 年 6 月），结合了原住民人群和风湿性疾病的检索词。如果研究报告了四个国家原住民人群的死亡率（粗频率、死亡率、生存率和潜在寿命损失（PYLL））测量值，则纳入研究。
在 5269 篇标题和摘要中，有 504 篇进行了全文审查，其中 12 篇被纳入。未发现来自新西兰的研究。在五项关于系统性红斑狼疮（SLE）患者的加拿大研究中，在调整了疾病和社会因素后，第一民族族裔与生存率降低相关，并且与白种人相比，狼疮及其并发症导致的死亡率增加。在调整了疾病和社会因素后，与 SLE 相关的所有原因死亡率在美洲原住民（n=2 项研究）中高于白人，但在狼疮肾炎患者中并非如此。澳大利亚原住民 SLE 患者经常因感染和狼疮并发症而死亡（n=3 项研究）。与没有 RA 的人相比，美国皮马印第安人患有类风湿关节炎（RA）的死亡率增加。在一项针对美国原住民硬皮病的研究中，发现几乎所有的死亡都与疾病进展有关。
与白人人群相比，加拿大和美国的原住民人群 SLE 的死亡率更高。在加拿大和澳大利亚的原住民人群中，SLE 以及在美国原住民人群中，RA 和硬皮病的死亡率经常归因于疾病进展或并发症。尚未全面评估风湿性疾病严重程度和社会因素对死亡率以及导致死亡的并发症的归因比例，以及在原住民和非原住民人群之间的差异。
