| アブストラクト | BACKGROUND: Granulomatosis with polyangiitis (GPA) is associated with an increased risk of mortality; however, recent mortality trends in GPA are unknown. We evaluated this issue in a general population context. METHODS: Using data collected between 1992 and 2013 by The Health Improvement Network in the United Kingdom, we identified individuals diagnosed as incident cases of GPA and up to 10 non-GPA controls matched on sex, age, year of birth, and year of GPA diagnosis. The cohort was divided into two based on the year of diagnosis (i.e., 1992-2002 and 2003-2013) to evaluate changes in mortality. We calculated hazard ratios for death using a Cox-proportional hazards model and the rate differences using an additive hazard model, while adjusting for potential confounders. RESULTS: We identified 465 cases of GPA (mean age: 60 years, 52% male). The early cohort (1992-2002) GPA patients had considerably higher mortality rates than the late cohort (2003-2013) (i.e., 72.0 vs. 35.7 cases per 1000 person-years), as compared with a moderate improvement in the comparison cohorts between the two periods (19.8 vs. 17.0 cases per 1000 person-years). The corresponding absolute mortality rate difference was 52.2 (95% CI: 25.1-79.2) cases and 18.7 (95% CI: 8.3-29.1) cases per 1000 person-years (p for interaction = 0.025). The resulting HRs for mortality were 4.34 (95% CI: 2.72-6.92) and 2.41 (95% CI: 1.74-3.34), respectively (p for interaction = 0.043). CONCLUSION: This population-based study suggests that survival of GPA patients has improved considerably over the past 2 decades, affirming the benefits of recent trends in the management of GPA and its complications. |
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| ジャーナル名 | Seminars in arthritis and rheumatism |
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| Pubmed追加日 | 2015/9/2 |
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| 投稿者 | Wallace, Zachary S; Lu, Na; Unizony, Sebastian; Stone, John H; Choi, Hyon K |
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| 組織名 | Rheumatology, Allergy, and Immunology Division, Massachusetts General Hospital,;Harvard Medical School, Boston, MA. Electronic address: zswallace@partners.org.;Harvard Medical School, Boston, MA; Clinical Epidemiology and Training Unit,;Boston University School of Medicine, Boston, MA.;Harvard Medical School, Boston, MA. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/26323883/ |
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