Mortality In United States Veterans With The HLA-B27 Gene

Jessica Walsh¹, Brian C. Sauer², Daniel O. Clegg¹, Grant W. Cannon³, Xi Zhou⁴ and Chiachen Teng⁴, ¹Division of Rheumatology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, UT, ²Epdemiology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, UT, ³Division of Rheumatology, Salt Lake City VA and University of Utah, Salt Lake City, UT, ⁴Epidemiology, George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, UT

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: human leukocyte antigens (HLA), morbidity and mortality and spondylarthritis

Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment: Clinical Features of Spondylarthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose : HLA-B27 (B27) is carried by in 6-8% of Americans and is strongly associated with spondyloarthritis (SpA). SpA has been associated with premature mortality. However, increased mortality was not suspected in B27 positive (B27+) individuals without SpA, until recently published data from the 2009 National Health and Nutrition Examination Survey reported a lower prevalence of B27 in randomly selected people older than 50, compared to younger people (7.3% vs. 3.6%, OR 0.4, CI 0.3-0.8). The purpose of this study was to better define the relationship between the B27 gene and mortality, by comparing mortality in B27+ and B27- veterans with clinically available B27 test results. Methods: The Corporate Data Warehouse was used to identify veterans with available B27 test results. Mortality differences between B27+ and B27- veterans were compared with Cox proportional hazard ratios. Logistic regression was used to evaluate the relationships between death and covariates including age at B27 testing, sex, race, and SpA diagnoses codes from rheumatology encounters. Results : Among 17,209,732 veterans, 32,327 had both available vital status data and B27 test results (Figure 1). The mean age at testing was 50.5 for B27+ and 50.1 for B27- veterans. Male gender was recorded in 92.9% of B27+ veterans and 88.3% of B27- veterans (Table 1). The hazard ratio comparing mortality in B27+ and B27- veterans was 1.16 (CI 1.04 – 1.30), after adjustment for age at B27 testing, sex, race, and SpA codes (Table 2). Conclusion: Mortality was higher in B27+ veterans than B27- veterans, and the difference was not explained by age, sex, race, or SpA diagnoses codes. The mortality difference was likely conservative because the B27- group may have been disproportionately enriched with conditions mimicking SpA that are associated with increased mortality, such as chronic pain or rheumatoid arthritis. Additional research is required to estimate survival in unselected individuals from the general population and to identify specific disease processes that contribute to premature mortality. Recognizing these diseases may provide mechanistic insights into B27 functions and may lead to interventions that improve survival in B27+ individuals.

Disclosure:

J. Walsh,
None;

B. C. Sauer,
None;

D. O. Clegg,
None;

G. W. Cannon,
None;

X. Zhou,
None;

C. Teng,
None.

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