Kwon Oh Chan, Lee See Young, Chun Jaeyoung, Han Kyungdo, Kim Yuna, Kim Ryul, Park Min-Chan, Kim Jie-Hyun, Youn Young Hoon, Park Hyojin
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Med (Lausanne). 2023 Jun 20;10:1185300. doi: 10.3389/fmed.2023.1185300. eCollection 2023.
Immune-mediated inflammatory disease (IMID) is associated with an increased risk of mortality. It is unclear whether the higher mortality is attributable to the IMIDs themselves or to the higher prevalence of comorbidities in IMIDs. We aimed to investigate whether IMIDs confer a higher risk of mortality.
From the Korean National Health Insurance Service-National Sample Cohort database, this population-based cohort study included 25,736 patients newly diagnosed with IMIDs between January 2007 and December 2017, and 128,680 individuals without IMIDs who were matched for age, sex, income, hypertension, type 2 diabetes, dyslipidemia, and the Charlson comorbidity index. All individuals were retrospectively observed through December 31, 2019. The outcomes included all-cause and cause-specific mortalities. Adjustments for age, sex, and comorbidities were performed using multivariable Cox proportional hazard regression analyses, and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the outcomes were estimated.
The adjusted risk of all-cause mortality was significantly lower in patients with IMIDs than that in those without (aHR, 0.890; 95% CI, 0.841-0.942). Regarding cause-specific mortality, cancer-specific (aHR, 0.788; 95% CI, 0.712-0.872) and cardiovascular disease-specific (aHR, 0.798; 95% CI, 0.701-0.908) mortalities were the two causes of death that showed significantly lower risks in patients with IMIDs. A similar trend was observed when organ based IMIDs were analyzed separately (i.e., gut, joint, and skin IMIDs).
After adjusting for comorbidities, IMIDs were associated with a lower risk of all-cause mortality compared to those without IMIDs. This was attributable to the lower risks of cancer-and cardiovascular disease-specific mortalities.
免疫介导的炎症性疾病（IMID）与死亡风险增加相关。目前尚不清楚较高的死亡率是归因于IMID本身，还是归因于IMID中共病的较高患病率。我们旨在调查IMID是否会带来更高的死亡风险。
基于韩国国民健康保险服务-全国样本队列数据库，这项基于人群的队列研究纳入了2007年1月至2017年12月期间新诊断为IMID的25736例患者，以及128680例无IMID的个体，这些个体在年龄、性别、收入、高血压、2型糖尿病、血脂异常和查尔森合并症指数方面进行了匹配。所有个体均进行回顾性观察至2019年12月31日。结局包括全因死亡率和特定病因死亡率。使用多变量Cox比例风险回归分析对年龄、性别和合并症进行调整，并估计结局的调整风险比（aHR）及95%置信区间（CI）。
IMID患者的全因死亡调整风险显著低于无IMID患者（aHR，0.890；95%CI，0.841-0.942）。关于特定病因死亡率，癌症特异性死亡率（aHR，0.788；95%CI，0.712-0.872）和心血管疾病特异性死亡率（aHR，0.798；95%CI，0.701-0.908）是IMID患者死亡风险显著较低的两个死因。当分别分析基于器官的IMID（即肠道、关节和皮肤IMID）时，观察到类似趋势。
在调整合并症后，与无IMID患者相比，IMID患者的全因死亡风险较低。这归因于癌症和心血管疾病特异性死亡率较低。
