Background Systemic lupus erythematosus (SLE) is associated with an increased risk of mortality. However, recent mortality trends in SLE are unknown, particularly at the general population level. Our objective was to assess mortality trends among SLE patients between January 1, 1997 and December 31, 2012 in a general population context.
Materials and methods Using an administrative health database from the province of British-Columbia, Canada (population ∼ 4.5 million), we identified all incident cases of SLE and up to 10 (3were selected) non-SLE controls matched based on sex, age, and calendar year of study entry, between 1997 and 2012. The SLE cohort was then divided in two cohorts based on year of SLE diagnosis (i.e., 1997–2004 and 2005–2012) to evaluate changes in mortality over time. We calculated hazard ratios (HR) for death using Cox proportional hazard models and the rate difference using an additive hazard model, while additionally adjusting for possible confounders (i.e., Charlson Comorbidity Index, number of outpatient visits, hospitalizations, cardiovascular disease medications, glucocorticoids and NSAIDs at baseline).
Results The early cohort (1997–2004) of SLE patients had a considerably higher mortality rate than the late cohort (2005–2012) (i.e., 67.33 cases vs. 25.98 cases per 1000 person-years). In contrast, only a moderate improvement was observed in comparison cohorts between the two periods (11.39 to 7.23 per 1000 person-years, respectively). The corresponding absolute mortality rate differences were 40.3 (95% CI: 33.0, 47.7) and 6.4 (95% CI: 2.9, 9.9) cases per 1000 person years (p-value for interaction < 0.001). The corresponding adjusted HRs for mortality were 3.95 (95% CI: 3.24, 4.83) and 2.41 (95% CI: 2.01, 2.89), respectively (p for interaction < 0.001).
Conclusions This population-based study shows that survival of SLE patients has improved over the past decade, suggesting that new treatments and improved management of the disease and its complications may be providing substantial benefits.
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