| アブストラクト | OBJECTIVES: Dupuytren's disease (DD) is a common, chronic, fibroproliferative disease of the palmar fascia. The aetiology is unclear, but includes genetic predisposition alongside environmental factors. Several studies have suggested an association between DD and excess mortality. We aimed to evaluate this association in adult patients in the United Kingdom, and identify the causes of mortality. METHODS: We used a large primary care database (Clinical Practice Research Datalink) linked to the Office of National Statistics to identify DD patients between 01/01/1995-31/12/2013. Each patient was matched by age, sex and GP practice to five DD-free controls. We used Cox regression models to study the association between DD and all-cause and cause-specific mortality, adjusting for confounders. RESULTS: We identified 41965 DD patients and 209825 controls. All-cause mortality was increased in both unadjusted (HR 1.48, 99% CI 1.29-1.70, p<0.0001) and multivariable adjusted (HR 1.43, 1.25-1.65, p<0.0001) models in patients with DD, 12 years following diagnosis. Excess mortality was secondary to a wide range of causes, including cancer (HR 1.66,1.27-2.17, p<0.0001), an effect that persisted after adjustment for confounders. CONCLUSION: There is excess mortality associated with DD that can be partially explained through environmental factors. From time of diagnosis in primary care, there is a 12-year window of opportunity for intervention to reduce the impact of these factors. We observed an increased risk of cancer mortality independent of confounders, and hypothesise a shared genetic risk between DD and cancer. |
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