Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2019 Jan 8;14(1):e0210471. doi: 10.1371/journal.pone.0210471. eCollection 2019.
We investigated the mortality and disability rate, as well as the healthcare expenditure, for patients with newly diagnosed seropositive rheumatoid arthritis (RA) who were followed-up for up to 10 years, compared to the general population in Korea.
We conducted a nationwide population-based study using a National Health Insurance Service-National Sample Cohort of the Korean population, consisting of 1 million individuals who submitted medical care claims between 2002 and 2013. RA was identified using as the International Classification of Diseases code M05 (seropositive RA), with prescription of any disease-modifying anti-rheumatic drug (DMARD). Our analysis was based on the data of 1655 patients with incident seropositive RA and 8275 non-RA controls. The controls were matched to the RA cohort by sex, age at the time of diagnosis, duration of follow-up, geographic region, type of social security, and household income.
The most commonly used conventional synthetic DMARDs were hydroxychloroquine (71.30%) and methotrexate (69.5%), with adalimumab being the most commonly used biologic DMARD (2.54%). The mortality rate was significantly higher in the RA than the control group (incidence rate ratio [IRR] 1.29, 95% confidence interval [CI] 1.02-1.64) in the first 10 years after diagnosis. Specifically, mortality due to infectious diseases (IRR 4.41, 95% CI 1.60-12.17) and pneumonia (IRR 3.92, 95% CI 1.46-10.53) was significantly higher in the RA than control group. The disability rate was higher in the RA than control group over the first 10 years of the disease (IRR 2.27, 95% CI 1.77-2.92), which was attributed to a higher incidence of physical disability (IRR 3.81, 95% CI 2.81-5.15). Annual health expenditure was greater for the RA than the control group.
Therefore, the rate of mortality and disability, as well as healthcare expenditure, are higher for patients with RA over the first 10 years of the disease onset, than the general population of Korea. The use of claim data has limited the quality of information and there is a limit to the observation period, and we expect the prospective national-wide multicenter cohort for longer period to overcome these limitations.
我们调查了新诊断为血清阳性类风湿关节炎（RA）的患者在 10 年内的死亡率和残疾率，以及医疗支出，与韩国的一般人群进行了比较。
我们使用韩国国民健康保险服务-国家样本队列的全国性基于人群的研究，该队列由 2002 年至 2013 年期间提交医疗费用报销的 100 万人组成。RA 是通过国际疾病分类代码 M05（血清阳性 RA）识别的，同时开具任何疾病修正抗风湿药物（DMARD）。我们的分析基于 1655 名新诊断的血清阳性 RA 患者和 8275 名非 RA 对照组的数据。对照组通过性别、诊断时的年龄、随访时间、地理区域、社会保障类型和家庭收入与 RA 队列相匹配。
最常用的常规合成 DMARD 是羟氯喹（71.30%）和甲氨蝶呤（69.5%），阿达木单抗是最常用的生物 DMARD（2.54%）。在诊断后 10 年内，RA 患者的死亡率明显高于对照组（发病率比[IRR] 1.29，95%置信区间[CI] 1.02-1.64）。具体而言，RA 患者传染病（IRR 4.41，95%CI 1.60-12.17）和肺炎（IRR 3.92，95%CI 1.46-10.53）死亡率明显高于对照组。在疾病的前 10 年内，RA 患者的残疾率高于对照组（IRR 2.27，95%CI 1.77-2.92），这归因于身体残疾的发生率较高（IRR 3.81，95%CI 2.81-5.15）。RA 患者的年医疗支出高于对照组。
因此，在疾病发病的前 10 年内，RA 患者的死亡率、残疾率和医疗支出均高于韩国一般人群。由于使用索赔数据，信息质量受到限制，并且观察期有限，我们预计未来将进行全国性、多中心、更长时间的前瞻性队列研究，以克服这些限制。
