Session Information
Date: Sunday, November 8, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment I: Epidemiology and Prognosis
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Systemic Lupus Erythematosus (SLE) is associated with an increased risk of mortality. However, recent mortality trends of SLE are unknown, particularly at the general population level. Our objectives were to assess mortality trends among SLE patients between January 1, 1997 and December 31, 2012 in a general population context.
Methods: Using an administrative health database from the province of British-Columbia, Canada (4.5 million), we identified all incident cases of SLE and up to 10 (3 were selected) non-SLE controls matched on sex, age, and calendar year of study entry, between 1997 and 2012. The SLE cohort was then divided in two cohorts based on year of SLE diagnosis (i.e., 1997-2004 and 2005-2012) to evaluate changes in mortality. We calculated hazard ratios (HR) for death using Cox proportional hazard model and the rate difference using an additive hazard model, while additionally adjusting for possible confounders (i.e. Charlson Comorbidity Index, number of outpatient visits, hospitalization, cardiovascular medications, glucocorticoids and NSAIDs at baseline).
Results: The early cohort (1997-2004) SLE patients had a considerably higher mortality rate than the late cohort (2005-2012) (i.e., 67.33 cases vs. 25.98 cases per 1000 person-years), as compared with only a moderate improvement in comparison cohorts between the two periods (11.39 to 7.23 per 1000 person-years, respectively). The corresponding absolute mortality rate differences were 40.3 (95% CI 33.0, 47.7) and 6.4 (95%CI 2.9, 9.9) cases per 1000 person years (p-value for interaction <0.001). The corresponding adjusted HRs for mortality were 3.95 (95% CI, 3.24, 4.83) and 2.41 (95% CI, 2.01, 2.89), respectively (p for interaction = < 0.001).
Conclusion: This population-based study shows that survival of SLE patients has improved over the past decade, suggesting the new treatments and improved management of the disease and its complications may be providing substantial benefits.
Table 1: Incidence Rates and Hazard Ratios (HR) for Associations between SLE and Death According to Cohort
|
|
SLE Status |
N |
Deaths |
Mean Follow-up (years) |
Incidence Rate (cases per 1000 person-years) |
Age, Sex and Entry-Time Matched IRR (95% CI) |
Fully Adjusted HR (95% CI) |
|
Total |
Yes |
5,304
|
821
|
4.65
|
33.28
|
3.56 (3.23, 3.93) |
2.80 (2.49, 3.16)
|
|
No |
15,912
|
836
|
5.63
|
9.34
|
1.00 |
1.00 |
|
|
Female |
Yes |
4,521 |
611 |
4.81 |
28.11 |
3.60 (3.21, 4.03) |
2.77 (2.41, 3.18) |
|
No |
13,563 |
603 |
5.69 |
7.82 |
1.00 |
1.00 |
|
|
Male |
Yes |
783 |
210 |
3.75 |
71.52 |
3.80 (3.14, 4.59) |
2.95 (2.33, 3.75) |
|
No |
2,349 |
233 |
5.27 |
18.84 |
1.00 |
1.00 |
|
|
1997-2004 |
Yes |
1,656 |
334 |
3.00 |
67.33 |
5.91 (4.96, 7.06) |
3.95 (3.24-4.83) |
|
No |
5,022 |
209 |
3.65 |
11.39 |
1.00 |
1.00 |
|
|
2005-2012 |
Yes |
3,630 |
287 |
3.04 |
25.98 |
3.59 (3.03, 4.26) |
2.41 (2.01-2.89) |
|
No |
10,890 |
262 |
3.33 |
7.23 |
1.00 |
1.00 |
To cite this abstract in AMA style:
Vostretsova K, Rai SK, Sayre EC, Choi HK, Esdaile J, Avina-Zubieta JA. Improved Survival in Systemic Lupus Erythematosus: A Population-Based Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/improved-survival-in-systemic-lupus-erythematosus-a-population-based-study/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/improved-survival-in-systemic-lupus-erythematosus-a-population-based-study/