Background/Purpose: There is little epidemiological data on mortality in spondyloarthritis (SpA). This study aimed to determine countries’ mortality rates of ankylosing spondylitis (AS) and psoriatic arthritis (PsA), as well as chronic inflammatory bowel diseases (IBDs), which are related to SpA, and to describe their evolution between 2001 and 2015.

Methods: We used mortality data from the World Health Organisation (WHO), freely available on its website, which shows the number of deaths classified by age, sex, and cause of death coded by ICD-10. The code M45 was used for AS, L405 for PsA, K50 for Crohn’s disease (CD), and K51 for ulcerative colitis (UC). Age-standardized mortality rates (ASMR) were constructed using the 2015 WHO reference population and are expressed as deaths per million inhabitants. Temporal trend analyses of ASMR were performed between 2001 and 2015, considering only countries with up to 3 years of missing data, using joinpoint regression.

Results: In 2015, the global ASMR of AS was 0.13 (0.11-0.14), ranging from 0.02 in Japan to 2.00 in Iceland (Figure 1A). The ASMR was 0.20 (0.18-0.23) for men and 0.07 (0.06-0.09) for women (p < 0.0001). The trend analysis did not show any significant variation between 2001 and 2015 (Figure 2A). The ASMR in Europe (0.17 (0.15-0.20)) was significantly higher than in North America (0.12 (0.09-0.14)) (p=0.008), South America (0.09 (0.06-0.12)) (p=0.0001) and Asia (0.08 (0.05-0.10)) (p < 0.0001).

For PsA, the global ASMR in 2015 was 0.04 (0.03-0.05), ranging from 0.01 in Mexico to 0.13 in Greece (Figure 1B). The ASMR was 0.06 (0.04-0.07) for men and 0.03 (0.02-0.04) for women (p=0.01). The trend analysis showed a significant increase from 2004 to 2015 with a mean annual percent change (APC) of 5.94% (p=0.02) (Figure 2B). The ASMR in Europe (0.05 (0.03-0.06)) was significantly higher than in South America (0.02 (0.00-0.03)) (p=0.02).

For CD, the global ASMR in 2015 was 0.86 (0.82-0.89), ranging from 0.02 in Thailand to 5.25 in Luxembourg (Figure 1C). The ASMR was 0.41 (0.38-0.43) for men and 0.38 (0.36-0.41) for women (p=0.17). The trend analysis showed a significant decrease from 2001 to 2015 with a mean APC of -0.82% (p=0.048) (Figure 2C). The ASMR in Europe (1.12 (1.05-1.19)) was significantly lower than in North America (1.31 (1.21-1.41)) (p=0.001), but significantly higher than in South America (0.57 (0.51-0.64)) (p < 0.0001) and Asia (0.27 (0.23-0.32)) (p < 0.0001).

For UC, the global ASMR in 2015 was 0.76 (0.73-0.79), ranging from 0.03 in Thailand to 5.48 in Saint Lucia (Figure 1D). The ASMR was 0.37 (0.35-0.39) for men and 0.23 (0.21-0.24) for women (p < 0.0001). The trend analysis showed a significant decrease from 2001 to 2015 with a mean APC of -1.29% (p=0.01) (Figure 2D). The ASMR in Europe (1.00 (0.93-1.06)) was significantly higher than in North America (0.64 (0.57-0.71)) (p < 0.0001), Africa (0.57 (0.41-0.72)) (p < 0.0001), South America (0.84 (0.76-0.91)) (p=0.003)), Asia (0.47 (0.93-1.06)) and Oceania (0.58 (0.38-0.79)) (p=0.003).

Conclusion: ASMR for IBD are higher than those for SpA and are decreasing over time, in contrast to SpA where they remain essentially stable. There are geographical disparities which must be interpreted with caution due to the declarative nature of the data.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/world-mortality-of-spondyloarthritis-and-inflammatory-bowel-diseases-in-2015-and-its-evolution-between-2001-and-2015/