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Abstract Number: 1804

Increased Mortality in Ankylosing Spondylitis – Results from a National Population Based Study

Sofia Exarchou1, Elisabeth Lie2, Johan Askling3, Helena Forsblad-d'Elia2, Carl Turesson1, Lars Erik Kristensen4 and Lennart T. Jacobsson2, 1Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden, 2Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden, 3Clinical Epidemiology Unit, Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden, 4Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS)

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Session Information

Session Title: Epidemiology and Public Health II: Osteoarthritis, Sedentary Behavior and more

Session Type: Abstract Submissions (ACR)

Background/Purpose: Ankylosing spondylitis (AS) is characterized both by inflammation of the axial skeleton and systemic inflammation, and may also involve joints, entheses and other organs. For other rheumatic chronic inflammatory diseases, such as rheumatoid arthritis, an increase in mortality compared to the background population has consistently been shown, whereas for AS, information on survival is scarce. The aims of the present study were to: 1) determine mortality in AS vs the general population, overall and by gender, and 2) to investigate factors associated with death in the AS cohort. 

Methods: From the National Patient Register (NPR) we identified a nationwide cohort of patients who were diagnosed with AS at a rheumatology or internal medicine department at least once between Jan 2001 and Dec 2009. A general population comparator, matched on year of birth, gender at the first registered diagnosis year of the AS patient, was identified from the census register, with 5 matched controls per index-patient. Socioeconomic variables and comorbidities (prior to the start of follow up) were identified from Statistics Sweden, NPR and the national Drug Prescription Register. The period of risk began on Jan 1st 2006 or at the first date of registered diagnosis thereafter in those with previously undiagnosed AS and extended until death, emigration, or Dec 31st 2012 (end of observation). Incidence Rate Ratios (IRR) were calculated when comparing mortality in AS and control cohorts and Cox regression models were used to determine predictors for death in the AS cohort.

Results: Among the 8 600 AS patients and the 40 460 controls, there were 496 and 1533 deaths, respectively (34% vs 31% due to cardiovascular disease – CVD). Mortality was increased in AS with an overall IRR of 1.71 (95% CI: 1.55 – 1.90), as well as for men (IRR = 1.65, 95% CI: 1.47 – 1.86) and women (IRR = 1.89, 95% CI: 1.55 – 2.29) in separate analyses. Male gender and higher age predicted death in the AS cohort. In addition, lower level of education and several comorbidities, both general (CVD, diabetes, pulmonary and malignant diseases) and AS-related (previous small or large joint surgery) were associated with increased risk of death in age/-sex adjusted analyses.

Conclusion: Mortality in this national, population-based AS cohort was increased both in men and women compared to matched controls from the general population. Both general and AS-related comorbidities predicted death suggesting that both traditional and AS-specific risk factors may affect survival.

 

Table: Predictors of Mortality in AS (age- and sex-adjusted analysis)

 

Baseline frequencies (%)

Hazard Ratio

95% CI

Higher education

(> 12 yrs vs. ≤ 12 yrs)

2648 (30.8)

0.67

0.52-0.85

Longer duration

(Diagnosis made before Jan 2006 vs after 2006)

5846 (68.0)

1.49

1.19-1.86

 

 

 

 

General comorbidities registered before start of follow up:

 

 

 

Cardiovascular disease or medication (CVD)

2954 (34.4)

2.04

1.62-2.55

Diabetes

418 (4.9)

1.94

1.52-2.47

Chronic lung disease

164 (1.9)

3.04

2.28-4.06

Malignancy

427 (5.0)

1.75

1.39-2.22

 

 

 

 

AS-related comorbidities registered before start of follow up:

 

 

 

Joint surgery (small or large joints)

645 (7.5)

1.44

1.15-1.81

Aortic valve insufficiency

79 (0.9)

1.24

0.71-2.15

Inflammatory bowel disease

644 (7.5)

1.29

0.97-1.73

Anterior uveitis

1731 (20.1)

0.90

0.70-1.15

Psoriasis

512 (6.0)

1.18

0.85-1.64

Peripheral arthritis

1841 (21.4)

1.18

0.96-1.45

 


Disclosure:

S. Exarchou,
None;

E. Lie,
None;

J. Askling,
None;

H. Forsblad-d’Elia,
None;

C. Turesson,
None;

L. E. Kristensen,
None;

L. T. Jacobsson,
None.

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