Session Information
Date: Monday, October 22, 2018
Title: 4M081 ACR Abstract: Edmond L. Dubois, MD Memorial Lecture: SLE–Clinical (1870–1874)
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: The major causes of early death in systemic lupus erythematosus (SLE) include active disease and infections, while cardiovascular complications and malignancies dominate the late stages. In recent years, there has been a significant decrease in all-cause mortality. The aim of the present study was to assess the all cause, age and cause-specific standardized mortality ratios (SMR) of lupus patients from 1971 to 2013.
Methods: Our long-term longitudinal cohort followed 1732 patients between 1971-2013. Causes of death were retrieved from death certificates, autopsy reports, hospital records or the records of the family physicians for each patient. They were categorized as atherosclerotic (acute coronary syndrome, ischemic cardiomyopathy, cerebrovascular accident), infection (sepsis), malignancy, active lupus and others. Patients were also categorized according to the age at death in 10-year intervals (15-24, 25-34 etc.). For the calculation of the SMR, data from the general population of Ontario, Canada were used (retrieved from Statistics Canada for the same time period). Statistical analysis was performed with SAS 9.4.
Results: Two hundred and forty-nine patients (205 females) died (infections 24.5%, atherosclerosis 15.7%, active lupus 13.3%, malignancy 9.6%); mean age was 53.2±16.6 years and mean disease duration 15.2±11.7 years. The mean age at death and SMRs for all-cause and cause-specific mortality over the decades are shown in Table 1.
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Table 1. Mean age at death and Standardized Mortality Ratio* (all-cause and cause-specific) for SLE from 1971 to 2013 |
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|
1971-79 |
1980-89 |
1990-99 |
2000-09 |
2010-2013 |
|
Mean age (y±SD) |
42.2±12.9 |
50.4±16.8 |
57.2±16.9 |
54.1±15.9 |
58.8±14.6 |
|
All-cause |
13.5 (8.6-18.5) |
6.5 (4.9-8.2) |
4.7 (3.6-5.8) |
3.2 (2.4-4) |
2.2 (1.4-3.1) |
|
Atherosclerosis |
|
8.3 (3.8-12.8) |
6.7 (3.8-9.5) |
2.3 (0.8-3.8) |
3.2 (0.1-6.3) |
|
Infection |
|
14.2 (8-20.4) |
6.5 (3.8-9.1) |
2.5 (1.2-3.9) |
0.9 (0-1.9) |
|
Malignancy |
|
14.1 (4.3-23.9) |
3 (1.1-4.8) |
4.4 (1.5-7.3) |
1.4 (0.2-2.7) |
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*As compared to the general population of Ontario, Canada (1971-2013). Values are given as SMR (95% Confidence Interval) |
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The age-specific SMR was particularly high in younger (15-44 years old) patients [SMR=12.4, 95%CI=9.7-15.1] as compared to the patients who were older than 45 years [SMR=3.1, 95%CI=2.6-3.6]. Details are given in Figure 1.
An analysis of the cause-specific SMR in the age groups 20-39 and >40 showed that younger patients had a higher SMR for all these causes, details in Table 2.
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Table 2. Cause-specific Standardized Mortality Ratio for patients 20-39 years old and ≥40 years (1978-2013) |
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Causes of death |
Deaths (20-39 years), n |
SMR (20-39 years) |
Deaths (≥ 40 years), n |
SMR (≥ 40 years) |
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All cause |
58 |
12.4 (95%CI=9.7-15.1) |
191 |
3.1 (95%CI=2.6-3.6) |
|
Atherosclerosis |
3 |
14.6 (95%CI=0-43.3) |
36 |
4.7 (95%CI=3.3-6) |
|
Infection |
30 |
30.2 (95%CI=14.4-46) |
31 |
3.5 (95%CI=2.5-4.5) |
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Malignancy |
4 |
31.9 (95%CI0.6-63.1) |
20 |
3 (95%CI=1.9-4.1) |
Conclusion: The SMR for all-cause and cause-specific mortality has significantly decreased over time, likely reflecting the advances in the management of SLE and atherosclerosis, infections and malignancies. The SMR is particularly high for younger patients (<40 years old) and it remains higher than that of the general population even for the older patients.
To cite this abstract in AMA style:
Tselios K, Gladman DD, Sheane B, Su J, Urowitz M. Age- and Cause-Specific Standardized Mortality Ratio of Systemic Lupus Erythematosus Patients in Ontario, Canada over 43 Years (1971-2013) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/age-and-cause-specific-standardized-mortality-ratio-of-systemic-lupus-erythematosus-patients-in-ontario-canada-over-43-years-1971-2013/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/age-and-cause-specific-standardized-mortality-ratio-of-systemic-lupus-erythematosus-patients-in-ontario-canada-over-43-years-1971-2013/