1. Systemic autoimmune disease as a cause of death: mortality burden and comorbidities.
- Author
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Mitratza M, Klijs B, Hak AE, Kardaun JWPF, and Kunst AE
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Autoimmune Diseases complications, Cause of Death, Comorbidity, Cost of Illness, Female, Humans, Male, Middle Aged, Netherlands epidemiology, Risk Factors, Sex Factors, Autoimmune Diseases mortality
- Abstract
Objectives: Systemic autoimmune diseases (SAIDs) have chronic trajectories and share characteristics of self-directed inflammation, as well as aspects of clinical expression. Nonetheless, burden-of-disease studies rarely investigate them as a distinct category. This study aims to assess the mortality rate of SAIDs as a group and to evaluate co-occurring causes of death., Methods: We used death certificate data in the Netherlands, 2013-2017 (N = 711 247), and constructed a SAIDs list at the fourth-position ICD-10 level. The mortality rate of SAIDs as underlying cause of death (CoD), non-underlying CoD, and any-mention CoD was calculated. We estimated age-sex-standardized observed/expected (O/E) ratios to assess comorbidities in deaths with SAID relative to the general deceased population., Results: We observed 3335 deaths with SAID on their death certificate (0.47% of all deaths). The mortality rate of SAID was 14.6 per million population as underlying CoD, 28.0 as non-underlying CoD, and 39.7 as any-mention CoD. The mortality rate was higher for females and increased exponentially with age. SAID-related deaths were positively associated with all comorbidities except for solid neoplasms and mental conditions. Particularly strong was the association with diseases of the musculoskeletal system (O/E = 3.38; 95% CI: 2.98, 3.82), other diseases of the genitourinary system (O/E = 2.73; 95% CI: 2.18, 3.38), influenza (O/E = 2.71; 95% CI: 1.74, 4.03), blood diseases (O/E = 2.02; 95% CI: 1.70, 2.39), skin and subcutaneous tissue diseases (O/E = 1.95; 95% CI: 1.54, 2.45), and infectious diseases (O/E = 1.85; 95% CI: 1.70, 2.01)., Conclusion: Systemic autoimmune diseases constitute a rare group of causes of death, but contribute to mortality through multiple comorbidities. Classification systems could be adapted to better encompass these diseases as a category., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
- Published
- 2021
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