Background/Purpose: Data from mostly small cohorts consistently suggest that a diagnosis of giant cell arteritis (GCA) does not substantially affect survival but GCA- and GCA treatment-related morbidity may result in specific patterns of causes of death. Large databases of death certificates allow for studying patterns of mortality associated with specific medical conditions and determining changes over time in the extent to which they contribute to mortality.

Methods: We obtained data from multiple-cause mortality files compiled by the French Epidemiological Center for the Medical Causes of Death (CépiDC) for 1980–2011. GCA cases were defined as decedents ≥55 years old with International Classification of Diseases (ICD) codes 446.5 (ICD-9) or M31.6 (ICD-10) listed as the underlying or contributory cause of death. We calculated annual death rates (using national census data as a denominator) and average ages at death for GCA and for the general French population; time trends were analyzed by linear regression. To investigate the relation between deaths associated with GCA due to other medical disorders, we calculated standardized mortality odds ratios (SMORs) for 16 conditions frequently listed as causes of death in the general population or with a known association with GCA morbidity or mortality. SMORs were computed from more detailed data from the death certificates from 2000 to 2011, in which GCA was listed as a contributory cause of death.

Results: Among the 14,927,440 death records compiled over the 32-year period for decedents ≥55 years old, 15,020 listed a diagnosis of GCA. Females accounted for 68% of GCA cases and 51% of general-population death records. GCA death rates increased from 1980 to 2000 (P<0.001) and decreased thereafter (P<0.001). Mean age at death for GCA patients was 83.6 years as compared with 79.6 years for the general population (≥55 years old); mean age at death from 1980 to 2011 increased by 6.4 years for patients with GCA (P<0.001) and by 3.2 years for the general population (P<0.001). From the analyses of 4,427 death certificates from 2000 to 2011, as compared with the general population (≥55 years old), GCA decedent certificates more often listed “arterial aneurysms/dissections” (SMOR: 2.42, 95% CI: 1.86–3.11), “hypertensive disease” (SMOR: 1.92, 95% CI: 1.64–2.23) or “infections (excluding pneumonia)” (SMOR: 1.77, 95% CI: 1.50–2.08) as the underlying cause of death but less often “malignant neoplasms (excluding blood cancers)” (SMOR: 0.46, 95% CI: 0.41–0.52).

Conclusion: The higher age at death with GCA as compared with the general population further supports that life expectancy is not decreased by GCA. The secular trends of increasing age at the time of death and the recent decline in GCA-associated death rates may reflect improved survival among GCA cases and/or a change in the epidemiological characteristics of GCA. Patients with GCA are at increased risk of dying from large-vessel disease and treatment-related co-morbidities, including cardiovascular disease and infection.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-associated-with-giant-cell-arteritis-from-1980-to-2011-an-analysis-of-the-french-national-death-certificate-database/