Department of General Medicine, China Medical University Hospital, No. 2, Yude Rd., North District, Taichung 404327, Taiwan.
School of Medicine, China Medical University, Taichung 404327, Taiwan.
Int J Environ Res Public Health. 2022 Nov 16;19(22):15088. doi: 10.3390/ijerph192215088.
Systemic sclerosis (SSc) has the highest mortality rate among autoimmune disorders. Individuals with SSc frequently die from complications or infections related to SSc. Nonetheless, the sex-age-period interaction of SSc is complex and remains unclear. The study aims to analyze the secular trend of SSc mortality based on data regarding underlying cause of death (UCD) and multiple causes of death (MCD) and clarify the sex-age interaction with time.
The multiple-cause mortality statistics provided by the National Center for Health Statistics were used to identify all deaths in the United States from 1981 to 2020 in which SSc was indicated anywhere on the death certificates. The age-standardized mortality rate (ASMR) was determined for both sexes, as well as the variations in these rates. Joinpoint regression analysis was utilized to determine the annual percentage change (APC) of ASMR.
A total of 44,672 and 66,259 individuals who died between 1981 and 2020 were identified based on the UCD and MCD data, respectively. According to the UCD data, SSc-related AMSR (SSc-ASMR) of the male and female decedents, respectively, declined from 5.01 and 1.94 in 1981-1990 to 4.77 and 1.32 in 2011-2020, respectively (mortality rate ratio 0.95, 95% confidence interval 0.92-0.98). From 1986 to 1999, the APC of SSc-ASMR in female decedents decreased except for those aged 45-64 years (APC 2.1%, = 0.002). For MCD analysis, in trend 1, only APC of SSc-ASMR in male decedents aged 45-64 years decreased. The SSc-ASMR of both male and female decedents fell on trend 2 arm. In 2011-2020, the ratio of UCD to MCD increased across all age groups for both sexes compared to 1981-1990. Overall, compared to the male decedents, the SSc-ASMR in female decedents increased significantly before 1999, peaked in 1999, followed by continuous decrease until 2020 according to UCD and MCD statistics.
Over the past four decades, the SSc deaths based on the MCD data were 1.48 times more than the UCD data, and the proportion of UCD over MCD increased over time. The SSc-ASMRs in all the sex-age groups significantly decreased over the past two decades. Notably, the mortality rate ratio of women to men with SSc increased in the past four decades.
系统性硬化症 (SSc) 是自身免疫性疾病中死亡率最高的疾病。患有 SSc 的人经常因与 SSc 相关的并发症或感染而死亡。尽管如此，SSc 的性别-年龄-时期相互作用仍很复杂，目前尚不清楚。本研究旨在根据死因根本原因（UCD）和多种死因（MCD）数据分析 SSc 死亡率的长期趋势，并阐明随时间推移的性别-年龄相互作用。
利用国家卫生统计中心提供的多死因死亡率统计数据，确定了美国在 1981 年至 2020 年间所有死因证书上注明有 SSc 的死亡病例。确定了男女的年龄标准化死亡率（ASMR）以及这些比率的变化。使用 Joinpoint 回归分析确定 ASMR 的年百分比变化（APC）。
根据 UCD 和 MCD 数据，分别确定了 1981 年至 2020 年期间共有 44672 人和 66259 人死亡。根据 UCD 数据，男性和女性死者的 SSc 相关 ASMR（SSc-ASMR）分别从 1981-1990 年的 5.01 和 1.94 降至 2011-2020 年的 4.77 和 1.32（死亡率比 0.95，95%置信区间 0.92-0.98）。1986 年至 1999 年，除 45-64 岁女性死者外，SSc-ASMR 的 APC 均呈下降趋势（APC 2.1%，=0.002）。对于 MCD 分析，在趋势 1 中，只有 45-64 岁男性死者的 SSc-ASMR APC 下降。男女死者的 SSc-ASMR 均呈趋势 2 手臂。2011-2020 年，与 1981-1990 年相比，男女所有年龄组的 UCD 与 MCD 的比例均有所增加。总体而言，根据 UCD 和 MCD 统计数据，与男性死者相比，女性死者的 SSc-ASMR 在 1999 年之前显著增加，在 1999 年达到峰值，随后持续下降至 2020 年。
在过去的四十年中，基于 MCD 数据的 SSc 死亡人数是 UCD 数据的 1.48 倍，并且 UCD 相对于 MCD 的比例随时间增加。在过去的二十年中，所有性别-年龄组的 SSc-ASMR 均显著下降。值得注意的是，在过去的四十年中，患有 SSc 的女性与男性的死亡率比增加了。
