Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Patients with inflammatory arthritis have a higher mortality than the general population due to increased risks of cardiovascular diseases, infection and cancer. As the treatment of inflammatory arthritis and its associated complications has improved significantly over the past decades, many studies have demonstrated a better survival in patients with inflammatory arthritis. However, it is unknown if the survival of patients with inflammatory arthritis in Hong Kong has also improved. Therefore, the aim of this study was to determine the trend in the mortality and the causes of death of different inflammatory arthritis in Hong Kong.
Methods:
The Hong Kong Hospital Authority is the only public healthcare service provider in Hong Kong. The Clinical Data Analysis and Report System (CDARS) captures diagnosis, medication prescriptions, laboratory parameters for all patients. Patients with a diagnosis of rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis from 1997 to 2016 were included in this analysis.
Patient demographics and causes of death were obtained. Results were analysed by R version 3.4.3 with package “epitools” version 0.5-10. Mortality rate and standardised mortality ratio (SMR) for all-cause mortality and cause-specific mortality were estimated every 5 years. Age and gender adjustment was conducted using census statistics provided by the Census and Statistics Department. A linear poisson regression analysis was performed to evaluate the change in SMR over time.
Results:
15445, 2165 and 4488 patients with RA, PsA and AS were included in this analysis respectively. Characteristics of the patients were summarised in Table 1. The SMR of RA, PsA and AS dropped significantly over 20 years (Table 2). There was a significant decrease in cardiovascular death in patients with RA and AS (Table 3; p<0.001). However, infection remained the leading cause of death and the mortality due to infection increased over the past 20 years.
Conclusion:
The mortality in patients with inflammatory arthritis in Hong Kong decreased significantly over the past 20 years.
Table 1. Characteristics of patients included in this study (cut-off date: 31/12/2016)
|
RA |
PsA |
AS |
|
|
n |
15445 |
2165 |
4488 |
|
Age |
61.9±0.1 |
55.86±0.27 |
49.6±0.22 |
|
Male (%) |
2952 (19.1%) |
1221 (56.4%) |
3580 (79.8%) |
|
Female (%) |
12493 (80.9%) |
944 (43.6%) |
908 (20.2%) |
|
Male:Female ratio |
1:4.23 |
1.29:1 |
3.94:1 |
Table 2. Age and gender-adjusted mortality rate, standardized mortality ratioof inflammatory arthritis in 1997-2016
|
Year |
1997-2001 |
2002-2006 |
2007-2011 |
2012-2016 |
|
RA |
||||
|
Mortality rate (/1000 PY) |
||||
|
Crude |
||||
|
RA |
46.86 [42.84-50.89] |
35.24 [32.82-37.65] |
26.20 [24.64-27.75] |
22.31 [21.14-23.48] |
|
AS |
33.50 [25.10-41.91] |
21.89 [17.99-25.78] |
17.27 [14.89-19.65] |
11.83 [10.28-13.38] |
|
PsA |
37.91 [21.70-54.13] |
17.74 [11.49-23.98] |
11.54 [8.41-14.68] |
9.61 [7.55-11.68] |
|
Age and gender-adjusted |
||||
|
RA |
21.46 [19.61-23.30] |
13.28 [12.37-14.19] |
18.75 [17.64-19.87] |
14.73 [13.96-15.50] |
|
AS |
17.89 [13.40-22.39] |
12.52 [10.29-14.75] |
14.76 [12.72-16.79] |
12.17 [10.58-13.77] |
|
PsA |
38.04 [21.77-54.31] |
14.33 [9.28-19.37] |
8.99 [6.54-11.43] |
7.57 [5.94-9.20] |
|
Age and gender-adjusted SMR |
||||
|
RA |
3.15 [2.89-3.43] |
2.30 [2.15-2.46] |
1.97 [1.86-2.10] |
1.77 [1.68-1.87] |
|
AS |
3.78 [2.94-4.86] |
2.57 [2.15-3.07] |
2.55 [2.22-2.93] |
1.84 [1.62-2.10] |
|
PsA |
5.98 [3.90-9.17] |
2.24 [1.58-3.19] |
1.50 [1.15-1.97] |
1.25 [1.01-1.56] |
Table 3. Cause of death in inflammatory arthritis patients in 1997-2016
|
1997-2001 |
2002-2006 |
2007-2011 |
2012-2016 |
|
|
RA |
N=520 |
N=819 |
N=840 |
N=1400 |
|
CV mortality |
100 (19.7%) |
112 (15.0%) |
130 (17.3%) |
193 (16.5%) |
|
Infection |
174 (34.2%) |
259 (34.8%) |
308 (41.0%) |
542 (46.4%) |
|
Cancer |
66 (13.0%) |
112 (15.0%) |
130 (17.3%) |
189 (16.2%) |
|
PsA |
N= 21 |
N= 31 |
N= 52 |
N= 83 |
|
CV mortality |
5 (23.8%) |
7 (25.0%) |
9 (19.6%) |
13 (18.1%) |
|
Infection |
6 (28.5%) |
10 (35.7%) |
14 (30.4%) |
28 (38.9%) |
|
Cancer |
3 (14.3%) |
4 (14.3%) |
14 (30.4%) |
15 (20.8%) |
|
AS |
N=61 |
N=121 |
N=202 |
N=224 |
|
CV mortality |
14 (23.3%) |
18 (16.7%) |
32 (18.0%) |
38 (19.6%) |
|
Infection |
16 (26.7%) |
31 (29.6%) |
58 (36.0%) |
83 (45.4%) |
|
Cancer |
12 (20.0%) |
25 (23.1%) |
27 (15.2%) |
33 (17.0%) |
To cite this abstract in AMA style:
Cheung TT, Tsoi SMF, Cheung BMY, Lau CS. Mortality and Causes of Death in Patients with Inflammatory Arthritis in Hong Kong over 20 Years [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/mortality-and-causes-of-death-in-patients-with-inflammatory-arthritis-in-hong-kong-over-20-years/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-and-causes-of-death-in-patients-with-inflammatory-arthritis-in-hong-kong-over-20-years/