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Mortality in ankylosing spondylitis: results from a nationwide population-based study

Journal article
Authors S. Exarchou
Elisabeth Lie
Ulf Lindström
J. Askling
Helena Forsblad d'Elia
C. Turesson
L. E. Kristensen
Lennart T. H. Jacobsson
Published in Annals of the Rheumatic Diseases
Volume 75
Issue 8
Pages 1466-1472
ISSN 0003-4967
Publication year 2016
Published at Institute of Medicine, Department of Rheumatology and Inflammation Research
Pages 1466-1472
Language en
Links dx.doi.org/10.1136/annrheumdis-2015...
Keywords single treatment course, x-ray therapy, register, cancer, sweden, cohort, spondyloarthritis, prevalence, arthritis, diseases, Rheumatology
Subject categories Rheumatology and Autoimmunity

Abstract

Objectives Information on mortality in ankylosing spondylitis (AS) is scarce. Our study therefore aimed to assess: (1) mortality in AS versus the general population, and (2) predictors of death in the AS population. Methods Nationwide cohorts of patients with AS diagnosed at rheumatology or internal medicine outpatient clinics (n=8600) and age-matched, sex-matched and county-matched general population comparators (n=40 460) were identified from the National Patient Register and the census register, respectively. The follow-up period began on 1 January 2006 or at the first date of registered diagnosis thereafter and extended until death, emigration or 31 December 2012, whichever occurred first. Socioeconomic variables, AS-related clinical manifestations, joint surgery, comorbidities and medication were identified from other national registers. Cox regression models were used to determine mortality and predictors for death in the AS cohort. Results There were 496 deaths in the AS cohort and 1533 deaths in the control cohort resulting in an age-adjusted and sex-adjusted HR of 1.60 (95% CI 1.44 to 1.77), with increased mortality for men (age-adjusted HR=1.53, 95% CI 1.36 to 1.72) and women (ageadjusted HR=1.83, 95% CI 1.50 to 2.22). Within the AS cohort, statistically significant predictors for death were a lower level of education, general comorbidities (diabetes, infections, cardiovascular, pulmonary and malignant diseases) and previous hip replacement surgery. Conclusions Mortality was increased for male and female patients with AS. Predictors of death within the AS cohort included socioeconomic status, general comorbidities and hip replacement surgery.

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