Kuo, C-F, Chou, I-J, Rees, F, Grainge, MJ, Lanyon, P, Davenport, G, Mallen, CD ORCID: 0000-0002-2677-1028, Chung, T-T, Chen, J-S, Zhang, W and Doherty, M (2018) Temporal relationships between systemic lupus erythematosus and comorbidities. Rheumatology. ISSN 0080-2727 (In Press)

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Abstract

Objective To examine the burden of comorbidities prior to and after the diagnosis of systemic lupus erythematosus (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 (ORs)) and after SLE diagnosis (incidence; hazard ratios (HRs)) and the impact of comorbidities at diagnosis on all-cause mortality were estimated. Results At diagnosis SLE was associated with adjusted ORs (95% confidence interval [CI]) of 2.25 (1.97-2.56), 3.37 (2.49-4.57) and 3.54 (1.89-6.63) for a Charlson comorbidity index of 1-2, 3-4 and ≥5, respectively. Following diagnosis SLE also associated with increased risk of developing any comorbidity with an adjusted HR (95% CI) of 1.30 (95% CI, 1.13-1.49). 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 HR of 1.91 (95% CI, 1.62-2.26); after further adjusting for comorbidities this reduced to 1.64 (1.37-1.97). Comorbidities at SLE diagnosis accounted for 27.6% of the apparent difference in mortality between SLE patients and matched controls. Conclusions People with SLE have increased risks of multiple comorbidities both prior to and after diagnosis and this contributes significantly to all-cause mortality. Keywords 1. Systemic lupus erythematosus 2. Comorbidities 3. Temporal relationships 4. All-cause mortality 5. Charlson comorbidity index 6. Epidemiology

Item Type: Article
Subjects: R Medicine > RC Internal medicine
Depositing User: Symplectic
Date Deposited: 28 Sep 2018 10:02
Last Modified: 19 Oct 2018 13:39
URI: http://eprints.keele.ac.uk/id/eprint/5378

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