University of Massachusetts Medical School, Worcester, and Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2018 Aug;70(8):1251-1256. doi: 10.1002/acr.23538. Epub 2018 May 28.
To examine whether giant cell arteritis (GCA) is associated with increased all-cause mortality and whether mortality differs according to age, sex, and calendar year of cohort entry.
Using the UK-based Clinical Practice Research Datalink, we identified 9,778 newly diagnosed GCA patients from 1990-2014, and up to 10 nonvasculitis patients randomly matched to each case on age, sex, practice, and years of history before cohort entry. We used Cox regression to estimate adjusted hazard ratios (HRs) for mortality of GCA patients in comparison to nonvasculitis patients, then stratified by age, sex, and calendar year of cohort entry.
Compared with nonvasculitis patients, GCA patients had increased mortality during the first year following diagnosis (adjusted HR 1.51, 95% confidence interval [95% CI] 1.40-1.64), and marginally increased mortality between 1 and 5 years after the diagnosis (adjusted HR 1.16, 95% CI 1.09-1.23), but not >5 years after the diagnosis (adjusted HR 1.06, 95% CI 1.00-1.12). GCA patients diagnosed before age 65 years had the highest mortality risk during the first year following diagnosis (adjusted HR 2.32, 95% CI 1.60-3.35). The mortality risk did not differ substantially by sex or calendar year of cohort entry.
GCA patients had an increased risk of mortality during the period shortly after the GCA diagnosis, in particular during the first year, but no increased risk after 5 years postdiagnosis. The mortality risk differed by age with an even greater increased 1-year mortality in those age <65 years at diagnosis, but not by sex or calendar year of cohort entry.
探讨巨细胞动脉炎（GCA）是否与全因死亡率增加相关，以及死亡率是否因年龄、性别和队列入组的年份而不同。
利用英国临床实践研究数据库，我们从 1990 年至 2014 年确定了 9778 例新诊断的 GCA 患者，并按年龄、性别、实践和队列入组前的病史年数，为每位患者随机匹配了至多 10 名非血管炎患者。我们使用 Cox 回归估计了 GCA 患者与非血管炎患者相比的死亡率调整后风险比（HR），然后按年龄、性别和队列入组年份进行分层。
与非血管炎患者相比，GCA 患者在诊断后第一年的死亡率增加（调整后的 HR 1.51，95%置信区间 [95%CI] 1.40-1.64），在诊断后 1 至 5 年期间的死亡率略有增加（调整后的 HR 1.16，95%CI 1.09-1.23），但在诊断后 >5 年时没有增加（调整后的 HR 1.06，95%CI 1.00-1.12）。诊断年龄 <65 岁的 GCA 患者在诊断后第一年的死亡率风险最高（调整后的 HR 2.32，95%CI 1.60-3.35）。死亡率与性别或队列入组的年份没有明显差异。
GCA 患者在 GCA 诊断后不久的一段时间内，特别是在第一年，死亡风险增加，但在诊断后 5 年以上，死亡风险没有增加。死亡率的风险因年龄而异，在诊断时年龄 <65 岁的患者中，1 年死亡率增加更为显著，但与性别或队列入组的年份无关。
