Background/Purpose

Ankylosing spondylitis (AS) is a chronic inflammatory joint disease that can lead to chronic pain in the axial and peripheral joints and to functional impairments. AS is a systemic disease that can cause extraarticular manifestations which could participate to excess mortality. The aim of the study is to describe characteristics of deaths for which AS was mentioned on the death certificate as either the underlying cause or anywhere on the death certificate and to analyze trends in AS related mortality from 1969 to 2009 in France.

Methods

Data were obtained from the Centre of Epidemiology on the Medical Causes of Death (CépiDc) for individuals aged 18 years and over died in France. Owing to implementation of International Classification of Diseases (ICD) 8, ICD-9 and ICD-10 for recording causes of deaths, three separate periods were analyzed (1969-78 ; 1979–99 and 2000–09). Initial, terminal and associated causes of deaths were analyzed. Initial Causes of deaths were compared with deaths of French general population in the same periods (CIM9 and 10).

Results

In the global period (1969-2009), AS appeared in 2942 deaths certificates, 2292 men (mean age of death 68,7 years) and 650 women (mean age of  75,8), 601 between 1969-78 (ICD8), 1471 between 1979-1999 (ICD9) and 867 between 2000 and 2009 (ICD10). There is a trend that AS decreases life expectancy in men compared with general population. The number of deaths with AS on the death certificates is increasing due to change of ICD and increase of diagnosis. AS is mentioned as initial cause in 38% in 1969-1978, 33% in 1979-1999 and 5% in 2000-2009. Apart from AS, most frequent initial causes are diseases of the circulatory system (28,5 % in ICD8,  23,1% in ICD9 and 26,5% in ICD10 ; neoplasms (7,8%, 10,2% and 16,3%) ; diseases of the respiratory system  (7,5%, 11,1% and 9,4%) and external causes of mortality (3,5%, 7,8% and 13,1%). Compared to general population there is less deaths caused by neoplasm, but more caused by infectious, genitourinary diseases and external causes of mortality. Most frequent associated causes are diseases of the circulatory system (22,2%, 34,4% and 23,7%).

Conclusion

The manner of death coding varies according to ICD. Our study is the first to analyze data from deaths certificate. Diseases of the circulatory system are the most frequent initial and associated causes of death. But compared to general population, infectious, genitourinary diseases and external causes of mortality are more frequent in AS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/deaths-associated-with-ankylosing-spondylitis-in-france-from-1969-to-2009/