美国医疗补助计划参保者中系统性红斑狼疮患者与非系统性红斑狼疮患者的骨折风险比较。
Comparative Fracture Risks Among United States Medicaid Enrollees With and Those Without Systemic Lupus Erythematosus.
机构信息
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
David Geffen School of Medicine at University of California, Los Angeles.
出版信息
Arthritis Rheumatol. 2019 Jul;71(7):1141-1146. doi: 10.1002/art.40818. Epub 2019 Jun 5.
OBJECTIVE
Poor bone health is common in systemic lupus erythematosus (SLE) patients. This study was undertaken to evaluate fracture risks among low-income SLE and lupus nephritis patients compared to those without SLE.
METHODS
We performed a cohort study among SLE patients for whom there were Medicaid claims in 2007-2010, and age- and sex-matched non-SLE comparators. SLE was defined by the presence of ≥3 International Classification of Diseases, Ninth Revision codes for SLE. Patients with lupus nephritis additionally had ≥2 codes for renal disease. The primary outcome measure was fracture of the pelvis, wrist, hip, or humerus. Demographics, prescriptions, and comorbidities were assessed during the 180-day baseline period. We calculated fracture incidence rates and 95% confidence intervals (95% CIs) in SLE, lupus nephritis, and non-SLE comparator cohorts, and estimated adjusted hazard ratios (HRs) for fractures. Sensitivity analyses evaluated the impact of glucocorticoids and comorbidities. We compared subsets of SLE patients with and those without lupus nephritis.
RESULTS
Among 47,709 SLE patients (19.8% with lupus nephritis) matched to 190,836 non-SLE comparators, the mean age was 41.4 years and 92.6% were female. The fracture incidence rate was highest among SLE patients with lupus nephritis (4.60 per 1,000 person-years). SLE patients had 2-fold higher fracture risks than matched comparators (HR 2.09 [95% CI 1.85-2.37]; P < 0.01). Lupus nephritis patients had the greatest fracture risks versus matched comparators (HR 3.06 [95% CI 2.24-4.17]; P < 0.01), and had a 1.6 times higher fracture risk than SLE patients without nephritis (HR 1.58 [95% CI 1.20-2.07]; P < 0.01). Adjustment for glucocorticoid use and comorbidities slightly attenuated risks.
CONCLUSION
Fracture risks were increased in SLE patients, particularly those with lupus nephritis, compared to matched non-SLE Medicaid recipients. Increased risks persisted after adjustment for baseline glucocorticoid treatment and comorbidities.
目的
红斑狼疮（SLE）患者普遍存在骨骼健康状况不佳的问题。本研究旨在评估低收入 SLE 患者和狼疮肾炎患者的骨折风险与无 SLE 患者相比情况如何。
方法
我们开展了一项队列研究，纳入了在 2007-2010 年期间有医疗补助索赔记录的 SLE 患者，并按照年龄和性别匹配了非 SLE 对照组患者。SLE 的定义为至少有 3 个国际疾病分类第 9 版 SLE 编码。患有狼疮肾炎的患者另外至少有 2 个肾病编码。主要结局测量指标是骨盆、手腕、髋部或肱骨骨折。在 180 天的基线期内评估了人口统计学、处方和合并症。我们计算了 SLE、狼疮肾炎和非 SLE 对照组队列的骨折发生率和 95%置信区间（95%CI），并估计了骨折的调整后风险比（HR）。敏感性分析评估了糖皮质激素和合并症的影响。我们比较了有和没有狼疮肾炎的 SLE 患者亚组。
结果
在 47709 名 SLE 患者（19.8%患有狼疮肾炎）与 190836 名非 SLE 对照组患者中，平均年龄为 41.4 岁，92.6%为女性。狼疮肾炎 SLE 患者的骨折发生率最高（4.60/1000 人年）。与匹配的对照组相比，SLE 患者的骨折风险高 2 倍（HR 2.09[95%CI 1.85-2.37]；P<0.01）。狼疮肾炎患者与匹配的对照组相比，骨折风险最高（HR 3.06[95%CI 2.24-4.17]；P<0.01），并且与无肾炎的 SLE 患者相比，骨折风险高 1.6 倍（HR 1.58[95%CI 1.20-2.07]；P<0.01）。调整糖皮质激素使用和合并症后，风险略有降低。
结论
与匹配的非医疗补助接受者相比，SLE 患者，特别是狼疮肾炎患者，骨折风险增加。在调整基线糖皮质激素治疗和合并症后，风险仍然存在。
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