Session Information
Session Title: Epidemiology and Health Services Research: Epidemiology and Outcomes of Rheumatic Disease II
Session Type: Abstract Submissions (ACR)
Background/Purpose: Autoimmune diseases are chronic illnesses that cause significant and chronic disability in children and may lead to death. Using mortality data from 1995, Walsh and Rau showed that autoimmune disease deaths were the leading causes of death among young women. The objective of this study is to examine the trends in crude mortality rate in children for autoimmune diseases in the United States.
Methods: We selected 24 autoimmune diseases (Table 1) chosen by Jacobson et al using the criteria of Rose and Bona, who defined autoimmune diseases as having direct proof or indirect evidence of autoimmune pathogenesis. Every autoimmune disease was classified with ICD-10 diagnosis code(s). Using the information provided by the Center for Disease Control (CDC), we reviewed all mortality data from the period of 1999-2008 in 3 year intervals. CDC reports that >99% of all deaths in the United States are registered. Each death certificate that lists an autoimmune disease as the underlying cause of death was identified and counted. Age groups, crude mortality rates per 100,000 persons (=number of deaths/population*100,000), and total mortality changes (percent change) between 1998 and 2008 were defined and calculated. We also compared the number of autoimmune disease deaths to the top ten leading causes of death by age in 2008.
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Addison’s disease (E27.1, E27.2, E27.4) Autoimmune hemolytic anemia (D59.1) Chronic active hepatitis (K73) Glomerulonephritis (N00, N01, N03, N05, N18) Goodpasture’s syndrome (M31.0) Graves’ disease/hyperthyroidism (E05.0) Idiopathic thrombocytopenia purpura (D69.3) Insulin dependent diabetes (E10) Multiple sclerosis (G35) Myasthenia gravis (G70.0) Myocarditis (I40.1, I40.8, I40.9, I51.4, I51.8) Pemphigus vulgaris (L10.0) Pernicious anemia (D51.0) |
Relapsing polychondritis (M94.1) Polymyositis/dermatomyositis (M33) Primary biliary cirrhosis (K74.3) Rheumatic fever and Rheumatic heart disease (I00, I01, I02, I05, I06, I07, I08, I09) Rheumatoid arthritis (M05, M06, M08) Scleroderma (M34, L94.0, L94.1) Sjogren’s (M35.0) Systemic lupus erythematosus (M32) Thyroiditis (E06.3) Uveitis (H20.0, H20.1, H20.8, H20.9, H30) Vitiligo (L80) |
Table 1. Autoimmune Diseases (ICD-10 codes).
Results: Table 2 presents the crude mortality rates of autoimmune diseases from 1999, 2002, 2005, and 2008 and the percent change between 1999 and 2008. Mortality rates decreased from 5% to 33% in all age groups except for children younger than 5 years old. The absolute numbers of autoimmune disease death did not increase over time. Likewise, mortality rates for all causes decreased for all age group under 20 years old. Despite a sharp decline in mortality rates, autoimmune diseases continue to be a leading cause of death among children (Table 3).
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|
Age |
Crude Mortality Rate (=Deaths/Population*100,000) |
% Change Between 1999 and 2008 |
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|
1999 |
2002 |
2005 |
2008 |
|||
|
Autoimmune Diseases |
1-4 5-9 10-14 15-19 20-24 |
0.33 0.19 0.26 0.60 1.05 |
0.22 0.11 0.21 0.56 0.97 |
0.26 0.14 0.21 0.49 1.01 |
0.35 0.18 0.19 0.40 0.93 |
6.06% -5.26% -26.92% -33.33% -11.43% |
|
All Causes of Death |
1-4 5-9 10-14 15-19 20-24 |
34.22 16.86 20.39 68.6 90.78 |
31.19 15.17 19.55 67.79 95.15 |
29.36 14.52 18.05 65.13 97.59 |
28.37 12.47 15.7 57.67 93.98 |
-17.10% -26.04% -23.00% -15.93% 3.53% |
Table 2. Trends in crude mortality rates for autoimmune diseases and all causes of death. Crude mortality rates are expressed per 100,000 persons.
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Age |
Relative Rank |
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1-4 |
#8 |
|
5-9 |
#10 |
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10-14 |
#9 |
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15-19 |
#6 |
|
20-24 |
#6 |
Table 3. Relative ranking of autoimmune disease deaths when compared to the official 10 leading causes of death in 2008.
Conclusion: Although mortality rates from autoimmune diseases appear to be declining in children 5-20 years of age, autoimmune diseases continue to rank within the top ten leading causes of death.
Disclosure:
E. Y. Yen,
None;
D. K. McCurdy,
None.
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