Arthritis Research Canada, Richmond.
Department of Medicine, Faculty of Medicine, Experimental Medicine Program, University of British Columbia, Vancouver.
Rheumatology (Oxford). 2021 May 14;60(5):2267-2276. doi: 10.1093/rheumatology/keaa579.
To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population.
We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected.
Overall, 23 545 RA and 47 090 general population experienced 658 and 1220 incident CVAs, respectively. A spline Cox model with a knot at year of onset 1999 was selected. A significant decline in risk of CVA was observed in individuals with RA onset after 1999 [0.90 (0.86, 0.95); P = 0.0001]. The change in CVA risk over time differed significantly in RA with onset from 1999 onwards compared with the general population (P-value of interaction term = 0.03), but not before 1999 (P = 0.06).
Our findings suggest that people with RA onset from 1999 onwards, had a significantly greater decline in 10-year risk of CVA compared with the general population.
评估在人群中，与普通人群相比，类风湿关节炎（RA）发病后 10 年内发生脑血管意外（CVA）的 10 年发病风险的长期变化趋势。
我们对加拿大不列颠哥伦比亚省的一个基于人群的 RA 发病队列进行了回顾性研究，该队列中 RA 的发病时间为 1997 年至 2004 年，RA 患者与普通人群（2：1）相匹配，使用行政健康数据。RA 和普通人群队列根据 RA 发病年份进行分组，根据病例定义中首次 RA 就诊的时间来定义。CVA 的发病定义为从首次 RA 就诊开始的 10 年内首次发生 CVA。采用双向交互项滞后进入 Cox 模型评估发病趋势，该交互项包含 RA 发病年份和 RA 与普通人群的指标。比较 RA 发病年份的线性、二次和样条函数，以评估非线性效应。选择最低 Akaike 信息准则的模型。
共有 23545 名 RA 患者和 47090 名普通人群分别经历了 658 例和 1220 例 CVA 发病。选择了在发病年份 1999 处有结的样条 Cox 模型。观察到在 1999 年后发病的 RA 患者中，CVA 的发病风险显著下降[0.90（0.86，0.95）；P = 0.0001]。1999 年后发病的 RA 患者的 CVA 风险随时间的变化与普通人群的差异有统计学意义（交互项 P 值=0.03），但在 1999 年前发病的 RA 患者与普通人群无显著差异（P = 0.06）。
我们的研究结果表明，与普通人群相比，1999 年后发病的 RA 患者的 10 年 CVA 发病风险下降更为显著。
