Division of Connective Tissue Disease (Rheumatology), The University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Preventive Medicine (Biostatistics and Epidemiology), The University of Tennessee Health Science Center, Memphis, TN, USA.
Clin Rheumatol. 2024 Jan;43(1):227-232. doi: 10.1007/s10067-023-06776-5. Epub 2023 Sep 21.
Ankylosing Spondylitis (AS) is a chronic inflammatory condition that affects the axial skeleton. Recent studies have shown that mortality risk is higher in AS patients and that it is possibly related to disease activity and duration. Our aim was to investigate the leading causes and factors associated with mortality in hospitalized AS patients in the USA.
This is a case-control study using the Cerner Health Facts® database between 2015 and 2017. The search was done using ICD codes and administrative claims. Cases were hospitalized AS patients who died during that hospitalization, while controls were patients who survived. In addition to demographics, we collected data on the inpatient use of medications such as NSAIDs, as well as different comorbidities and systemic disease manifestations. The discharge diagnoses for deceased patients were collected to infer causes of mortality. Analysis of association was performed using chi-square tests, t-tests, Wilcoxon rank-sum tests, and logistic regression methods.
The leading causes of death were cardiovascular, infectious, respiratory, and traumatic. The Elixhauser comorbidity index was the factor most associated with mortality (p-value < 0.0001), with congestive heart failure and renal disease the most contributing. Drug use disorder was associated with mortality (adjusted OR = 10.9; p = 0.001). Inpatient NSAIDs use was not associated with increased odds for mortality (p-value 0.33).
Cardiovascular and renal comorbidities are associated with mortality and need to be targeted early on to lower the odds of mortality as patients age. Strategies to prevent opioid and drug abuse should be strengthened in the AS population. Key Points • Cardiovascular and renal comorbidities are associated with mortality and need to be screened for and targeted early on to lower the odds of mortality as patients age. • Drug use disorder including opioid dependence is associated with mortality, and strategies to prevent opioid and drug abuse should be strengthened in the AS population.
强直性脊柱炎（AS）是一种慢性炎症性疾病，影响中轴骨骼。最近的研究表明，AS 患者的死亡风险更高，且可能与疾病活动度和病程有关。我们的目的是研究美国住院 AS 患者死亡的主要原因和相关因素。
这是一项使用 Cerner Health Facts®数据库进行的病例对照研究，时间范围为 2015 年至 2017 年。使用国际疾病分类（ICD）代码和行政索赔进行搜索。病例为住院期间死亡的 AS 患者，对照组为存活的患者。除了人口统计学数据外，我们还收集了住院患者使用非甾体抗炎药（NSAIDs）等药物的数据，以及不同的合并症和全身性疾病表现。收集已故患者的出院诊断以推断死亡原因。使用卡方检验、t 检验、Wilcoxon 秩和检验和逻辑回归方法进行关联分析。
导致死亡的主要原因是心血管、感染、呼吸和创伤。Elixhauser 合并症指数是与死亡率最相关的因素（p 值<0.0001），充血性心力衰竭和肾脏疾病的贡献最大。药物使用障碍与死亡率相关（调整后的 OR=10.9；p=0.001）。住院 NSAIDs 使用与增加死亡率的几率无关（p 值 0.33）。
心血管和肾脏合并症与死亡率相关，需要早期筛查和靶向治疗，以降低患者随着年龄增长的死亡率。应该加强针对 AS 人群的阿片类药物和药物滥用预防策略。
心血管和肾脏合并症与死亡率相关，需要早期筛查和靶向治疗，以降低患者随着年龄增长的死亡率。
药物使用障碍包括阿片类药物依赖与死亡率相关，应该加强针对 AS 人群的阿片类药物和药物滥用预防策略。
