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All‐Cause and Cause‐Specific Mortality in Patients With Granulomatosis With Polyangiitis: A Population‐Based Study
Author(s) -
Tan Ju Ann,
Choi Hyon K.,
Xie Hui,
Sayre Eric C.,
Esdaile John M.,
AviñaZubieta J. Antonio
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23587
Subject(s) - medicine , granulomatosis with polyangiitis , cohort , hazard ratio , cause of death , proportional hazards model , cohort study , population , mortality rate , confidence interval , disease , vasculitis , surgery , environmental health
Objective To investigate all‐cause and cause‐specific mortality in patients with newly diagnosed granulomatosis with polyangiitis (GPA) between 2 calendar time periods, 1997–2004 and 2005–2012. Methods Using an administrative health database, we compared all patients with incident GPA with non‐GPA controls matched for sex, age, and time of entry into the study. The study cohorts were divided into 2 subgroups based on the year of diagnosis (“early cohort [1997–2004] and “late cohort” [2005–2012]). The outcome was death (all‐cause, cardiovascular disease [CVD]–related cancer‐related, renal disease–related, and infection‐related) during the follow‐up period. Hazard ratios (HR) were estimated using Cox proportional hazards models, first adjusted for age, sex, and time of entry and then adjusted for selected covariates based on a purposeful selection algorithm. Results Three hundred seventy patients with GPA and 3,700 non‐GPA controls were included in this study, contributing 1,624.8 and 1,8671.3 person‐years of follow‐up, respectively. Sixty‐eight deaths occurred in the GPA cohort, and 310 deaths occurred in the non‐GPA cohort. Overall, the age‐, sex‐, and entry time–adjusted all‐cause mortality HR in the GPA cohort was 3.12 (95% confidence interval CI 2.35–4.14). There was excess mortality due to CVD‐related causes, but not cancer, in the GPA cohort. Reports of death due to infection or renal disease was not permitted, because the numbers of death were insufficient (<6 deaths for each outcome). All‐cause mortality significantly improved between the early cohort and late cohort time periods (HR 5.61 and 2.33, respectively; P for interaction = 0.017). Conclusion This population‐based study showed increased all‐cause and CVD‐related mortality risks in patients with GPA. There was significant improvement in the all‐cause mortality risk over time, but the risk remained increased compared with that in the general population.