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类风湿关节炎与超额死亡率:虽有所下降,但仍未消除。一项基于临床实践研究数据链接的初级保健队列研究。

Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research Datalink.

机构信息

Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.

Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

出版信息

Rheumatology (Oxford). 2018 Jun 1;57(6):977-981. doi: 10.1093/rheumatology/key013.


DOI:10.1093/rheumatology/key013
PMID:29796636
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5965085/
Abstract

OBJECTIVES: To examine temporal trends in all-cause and cause-specific mortality in RA. METHODS: Data from the Clinical Practice Research Datalink were used. Incident RA cases and four age-, sex- and general practice-matched controls were identified from at-risk cohorts for each calendar year and followed-up for up to 5 years. Mortality rates and 95% CIs were computed. Cox proportional hazard ratios (HRs) were calculated to estimate associations and adjusted for covariates. The temporal trend in mortality was examined using the Joinpoint regression program. Data management and analysis were performed using Stata version 14. RESULTS: A total of 21 622 cases with incident RA and 86 488 controls were included. The mortality rate of RA cases and controls was 26.90 (95% CI 25.87, 27.97) and 18.92 (18.48, 19.36)/1000 person-years, respectively. The mortality rate in RA cases did not change significantly between 1990 and 2004 but decreased by 7.7%/year between 2005 and 2009. However, the mortality rate in controls improved steadily by 2.2%/year between 1990 and 2009. RA was associated with a 32% excess risk of mortality in the entire cohort [adjusted HR 1.32 (95% CI 1.26, 1.38)], but this was only 15% in cases incident after 2006 [adjusted HR 1.15 (95% CI 1.03, 1.29)]. Similarly, the HR of death due to cardiovascular diseases decreased in cases incident in recent years. CONCLUSION: The mortality rate in RA cases incident after the year 2006 has declined significantly, with a trend towards a decline in death from cardiovascular diseases. This could be due to improved management of RA. However, even in cohorts from recent years, RA still associates with higher mortality rates.

摘要

目的:研究类风湿关节炎(RA)全因和特定病因死亡率的时间趋势。

方法:使用临床实践研究数据链接中的数据。为每个日历年度从风险队列中确定了 RA 新发病例和 4 名年龄、性别和一般实践匹配的对照,并随访了长达 5 年。计算死亡率和 95%置信区间。使用 Cox 比例风险比(HR)计算来估计关联,并调整了协变量。使用 Joinpoint 回归程序检查死亡率的时间趋势。使用 Stata 版本 14 进行数据管理和分析。

结果:共纳入 21622 例 RA 新发病例和 86488 例对照。RA 病例和对照的死亡率分别为 26.90(95%CI 25.87,27.97)和 18.92(18.48,19.36)/1000 人年。1990 年至 2004 年期间,RA 病例的死亡率无显著变化,但 2005 年至 2009 年期间每年下降 7.7%。然而,1990 年至 2009 年期间,对照的死亡率稳步提高,每年提高 2.2%。整个队列中,RA 导致死亡率增加 32%(调整后的 HR 1.32[95%CI 1.26,1.38]),但 2006 年后新发病例的这一比例仅为 15%(调整后的 HR 1.15[95%CI 1.03,1.29])。同样,近年来新发病例的心血管疾病死亡风险 HR 下降。

结论:2006 年后新发病例的 RA 死亡率显著下降,心血管疾病死亡呈下降趋势。这可能是由于 RA 的管理得到了改善。然而,即使在近年来的队列中,RA 仍然与更高的死亡率相关。

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[9]
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本文引用的文献

[1]
Rheumatoid arthritis is getting less frequent-results of a nationwide population-based cohort study.

Rheumatology (Oxford). 2017-5-1

[2]
Improvement in 5-year mortality in incident rheumatoid arthritis compared with the general population-closing the mortality gap.

Ann Rheum Dis. 2017-6

[3]
Improved survival in rheumatoid arthritis: a general population-based cohort study.

Ann Rheum Dis. 2017-2

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Eur J Epidemiol. 2016-10

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Arthritis Care Res (Hoboken). 2015-8

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Joint Bone Spine. 2012-3-27

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Excess mortality emerges after 10 years in an inception cohort of early rheumatoid arthritis.

Arthritis Care Res (Hoboken). 2010-3

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