皮肌炎和多发性肌炎患者持续存在过早死亡率差距：一项基于英国普通人群的队列研究。
Persistent premature mortality gap in dermatomyositis and polymyositis: a United Kingdom general population-based cohort study.
机构信息
Division of Rheumatology, Allergy, and Immunology, Boston, MA, USA.
Department of Medicine, Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Rheumatology (Oxford). 2021 Jun 18;60(6):2653-2660. doi: 10.1093/rheumatology/keaa661.
OBJECTIVE
DM and PM are associated with substantial morbidity and mortality. We aimed to examine recent trends.
METHODS
Using The Health Improvement Network, we identified patients with incident DM/PM (defined by ≥1 Read diagnosis code) aged 18-89 years with ≥1 year of continuous enrolment prior to the cohort entry date and up to 10 comparators matched on age, sex and entry year. The cohort was divided in two based on the year of DM/PM diagnosis: the early cohort (1999-2006) and late cohort (2007-2014). We calculated multivariable hazard ratios (HR) for death using a Cox-proportional hazards model and multivariable rate differences (RD) using an additive hazard model.
RESULTS
We identified 410 DM cases (mean age: 58 years, 66% female) and 407 PM cases (mean age: 59 years, 61% female). Both DM cohorts had excess mortality compared with the comparison cohorts (71.5 vs 12.9 deaths/1000 person-years [PY] in the early cohort and 49.1 vs 10.4 deaths/1000 PY in the late cohort). The multivariable HRs were 7.51 (95% CI: 4.20, 13.42) in the early cohort and 5.42 (95% CI: 3.11, 9.45) in the late cohort (P-value for interaction = 0.59), and multivariable RDs were 56.2 (95% CI: 31.8, 81.2) in the early cohort and 36.3 (95% CI: 19.6, 53.0) in the late cohort (P-value for interaction = 0.15). A similar trend existed in PM.
CONCLUSION
The premature mortality gap in DM/PM has not considerably improved in recent years, highlighting an unmet need for therapeutic improvement.
目的
DM 和 PM 与大量发病率和死亡率相关。我们旨在研究近期趋势。
方法
使用健康改善网络（The Health Improvement Network），我们确定了年龄在 18-89 岁之间、有≥1 年连续入组记录且在队列入组日期前有≥1 次 DM/PM（通过≥1 次 Read 诊断代码定义）的患者，并按照年龄、性别和入组年份与≥1 名对照进行匹配。根据 DM/PM 诊断年份，队列分为两个亚组：早期队列（1999-2006 年）和晚期队列（2007-2014 年）。我们使用 Cox 比例风险模型计算死亡的多变量风险比（HR），并使用加法风险模型计算多变量率差（RD）。
结果
我们确定了 410 例 DM 病例（平均年龄：58 岁，66%为女性）和 407 例 PM 病例（平均年龄：59 岁，61%为女性）。与对照组相比，两个 DM 队列的死亡率均过高（早期队列为 71.5 例/1000 人年，晚期队列为 49.1 例/1000 人年）。多变量 HR 分别为早期队列的 7.51（95%CI：4.20，13.42）和晚期队列的 5.42（95%CI：3.11，9.45）（交互检验 P 值=0.59），多变量 RD 分别为早期队列的 56.2（95%CI：31.8，81.2）和晚期队列的 36.3（95%CI：19.6，53.0）（交互检验 P 值=0.15）。PM 也存在类似的趋势。
结论
近年来，DM/PM 的过早死亡差距并未明显改善，这突显了对治疗改善的未满足需求。
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