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Temporal relationships between systemic lupus erythematosus and comorbidities

Kuo, Chang Fu; Chou, I-Jun; Rees, Frances; Grainge, Matthew J.; Lanyon, Peter; Davenport, Graham; Mallen, Christian D; Chung, Ting Ting; Chen, Jung Sheng; Zhang, Weiya; Doherty, Michael

Authors

Chang Fu Kuo

I-Jun Chou

Frances Rees

Peter Lanyon

Graham Davenport

Christian D Mallen

Ting Ting Chung

Jung Sheng Chen

Michael Doherty



Abstract

© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Objective: To examine the burden of comorbidities prior to and after the diagnosis of SLE and its impact on mortality. Methods: We identified 1605 incident cases of SLE and 6284 matched controls from the UK primary care. The risks of comorbidities before (prevalence; odds ratios) and after SLE diagnosis (incidence; hazard ratios) and the impact of comorbidities at diagnosis on all-cause mortality were estimated. Results: At diagnosis, SLE was associated with adjusted odds ratios (95% CI) of 2.25 (1.972.56), 3.37 (2.494.57) and 3.54 (1.896.63) for a Charlson comorbidity index of 12, 34 and 55, respectively. Following diagnosis, SLE also associated with increased risk of developing any comorbidity with an adjusted hazard ratio (95% CI) of 1.30 (95% CI, 1.131.49). At diagnosis, SLE was associated with a greater risk of cancer, cardiovascular, renal, liver, rheumatological and neurological diseases as well as depression, anaemia and psoriasis. Risks of developing incident comorbidity in the categories of neoplasm, cardiovascular, genitourinary, metabolic/endocrine, gastrointestinal and hepatic diseases, chronic pulmonary diseases, musculoskeletal/connective tissue and neurological diseases were higher in SLE patients. People with SLE had higher mortality risk compared with controls, with adjusted hazard ratio of 1.91 (95% CI, 1.622.26); after further adjusting for comorbidities this reduced to 1.64 (1.371.97). Comorbidities at SLE diagnosis accounted for 27.6% of the apparent difference in mortality between SLE patients and matched controls. Conclusion: People with SLE have increased risks of multiple comorbidities both prior to and after diagnosis and this contributes significantly to all-cause mortality.

Journal Article Type Article
Publication Date May 1, 2019
Journal Rheumatology (United Kingdom)
Electronic ISSN 1462-0332
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 58
Issue 5
Pages 840-848
APA6 Citation Kuo, C. F., Chou, I., Rees, F., Grainge, M. J., Lanyon, P., Davenport, G., …Doherty, M. (2019). Temporal relationships between systemic lupus erythematosus and comorbidities. Rheumatology, 58(5), 840-848. https://doi.org/10.1093/rheumatology/key335
DOI https://doi.org/10.1093/rheumatology/key335
Publisher URL https://academic.oup.com/rheumatology/article/58/5/840/5253846

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