All-cause, cause-specific and age-specific standardised mortality ratios of patients with systemic lupus erythematosus in Ontario, Canada over 43 years (1971-2013).

Authors:
Dr Konstantinos Tselios, MD, PhD
Dr Konstantinos Tselios, MD, PhD
Toronto Western Hospital, University of Toronto
Clinical Research Fellow
Rheumatology
Toronto, Ontario | Canada
Dafna D Gladman
Dafna D Gladman
University of Toronto
Toronto | Canada
Barry J Sheane
Barry J Sheane
St James's Hospital
Ireland
Jiandong Su
Jiandong Su
University of Toronto
Canada
Murray Urowitz
Murray Urowitz
Toronto Western Hospital
Canada

Ann Rheum Dis 2019 Jun 16;78(6):802-806. Epub 2019 Apr 16.

Center for Prognosis Studies in the Rheumatic Diseases, Toronto Lupus Clinic, University Health Network, University of Toronto, Toronto, Ontario, Canada

Background: Survival in systemic lupus erythematosus (SLE) has improved substantially in the last 50 years. The aim of the present study was to assess the evolution of the all-cause, cause-specific and age-specific standardised mortality ratios (SMRs) of patients with lupus in Ontario, Canada.

Patients And Methods: Between 1971 and 2013, 1732 patients were followed in the Toronto Lupus Clinic. Causes of death were retrieved from death certificates, autopsy reports, hospital records or the records of the family physicians. They were categorised as atherosclerotic, infectious, malignancy, active lupus and others. For the calculation of the SMR (indirect standardisation method), data from the general population of Ontario, Canada were used (Statistics Canada).

Results: Two hundred and forty-nine patients (205 women) died (infections 24.5%, atherosclerosis 15.7%, active lupus 13.3%, malignancy 9.6%); mean age was 53.2±16.6 years and mean disease duration 15.2±11.7 years. The all-cause SMR was substantially decreased from the 1970s (13.5, 95% CI 8.6 to 18.5) to recent years (2.2, 95% CI 1.4 to 3.1). Similar trends were observed for atherosclerosis, infections and malignancies over time. The all-cause age-specific SMR was particularly high in younger (19-39 years old) patients (SMR=12.4, 95% CI 9.7 to 15.1) as compared with individuals older than 40 years (SMR=3.1, 95% CI 2.6 to 3.6). The cause-specific SMR was also higher in younger patients, particularly for infections and malignancies.

Conclusions: The all-cause and cause-specific SMR significantly decreased over time, likely reflecting the advances in the management of SLE and certain comorbidities. The all-cause and cause-specific SMR was particularly high for younger patients (<40 years old).

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http://dx.doi.org/10.1136/annrheumdis-2018-214802DOI Listing
June 2019
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