Haddad Amir, Saliba Walid, Lavi Idit, Batheesh Amin, Kasem Samir, Gazitt Tal, Feldhamer Ilan, Cohen Arnon Dov, Zisman Devy
A. Haddad, MD, T. Gazitt, MD, MSc, Division of Rheumatology, Carmel Medical Center, Haifa;
W. Saliba, MD, Department of Internal Medicine, Carmel Medical Center, and Department of Epidemiology, Clalit Health Services, Haifa.
J Rheumatol. 2022 Feb;49(2):165-170. doi: 10.3899/jrheum.210159. Epub 2021 Jul 15.
OBJECTIVE: To examine the association between psoriatic arthritis (PsA) and all-cause mortality from a large population-based database. METHODS: Patients with PsA from the Clalit Health Services database were identified between 2003-2018 and matched to 4 controls by age, sex, ethnicity, and index date. Patient demographics, comorbidities, and treatments were extracted. Mortality data were obtained from the Israeli Notification of Death certificate. The proportionate mortality rate (PMR) of the leading causes of death was calculated and compared to that of the general population. Cox proportional hazard regression models were used to estimate the crude and the multivariate adjusted HR for the association between PsA and all-cause mortality and for factors associated with mortality within the PsA group. RESULTS: There were 5275 patients with PsA and 21,011 controls included and followed for 7.2 ± 4.4 years. The mean age was 51.7 ± 15.4 years, and 53% were females. Among patients with PsA, 38.2% were on biologics. Four hundred seventy-one (8.9%) patients died in the PsA group compared to 1668 (7.9%) in the control group. The crude HR for the association of PsA and all-cause mortality was 1.16 (95% CI 1.04-1.29) and 1.02 (95% CI 0.90-1.15) on multivariate analysis. Malignancy was the leading cause of death (26%), followed by ischemic heart disease (15.8%); this is in keeping with the leading causes of death in the general population. Older age, male sex, lower socioeconomic status, increased BMI, increased Charlson comorbidity index scores, and history of psoriasis or hospitalization in 1 year prior to entry were positive predictors for mortality. CONCLUSION: No clinically relevant increase in mortality rate was observed in patients with PsA, and specific PMRs were similar to those of the general population.
目的:从一个基于大人群的数据库中研究银屑病关节炎(PsA)与全因死亡率之间的关联。 方法:在2003年至2018年间,从克拉利特医疗服务数据库中识别出PsA患者,并按照年龄、性别、种族和索引日期与4名对照进行匹配。提取患者的人口统计学信息、合并症和治疗情况。死亡率数据来自以色列死亡证明通知。计算主要死因的比例死亡率(PMR),并与普通人群进行比较。使用Cox比例风险回归模型估计PsA与全因死亡率之间关联的粗HR和多变量调整HR,以及PsA组内与死亡率相关的因素。 结果:纳入5275例PsA患者和21011名对照,随访7.2±4.4年。平均年龄为51.7±15.4岁,53%为女性。在PsA患者中,38.2%使用生物制剂。PsA组有471例(8.9%)患者死亡,而对照组有1668例(7.9%)。PsA与全因死亡率关联的粗HR为1.16(95%CI 1.04 - 1.29),多变量分析时为1.02(95%CI 0.90 - 1.15)。恶性肿瘤是主要死因(26%),其次是缺血性心脏病(15.8%);这与普通人群的主要死因一致。年龄较大、男性、社会经济地位较低、BMI增加、Charlson合并症指数评分增加以及入组前1年有银屑病或住院史是死亡率的阳性预测因素。 结论:未观察到PsA患者死亡率有临床相关增加,特定的PMR与普通人群相似。
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