本/期/解/读
类风湿关节炎和类风湿关节炎相关间质性肺病的死亡率及其发展趋势
Rheumatoid Arthritis and Associated-Interstitial Lung Disease: Mortality Rates and Trends
作者：
Niranjan Jeganathan, et al.
翻译：
浙大二院呼吸与危重症医学科 楼剑
北京协和医院呼吸与危重症医学科 黄慧
文献来源：Ann Am Thorac Soc. 2021 May 5. Online ahead of print.
doi:10.1513/AnnalsATS.202102-115OC
研究意义
类风湿关节炎（RA）及类风湿关节炎相关间质性肺病（RA-ILD）的疾病负担情况近年来还没有被很好地研究过。
目 的
本研究试图按人口统计资料进行分层，对美国2005-2018年间的RA及RA-ILD的死亡率及其发展趋势进行描述性研究。
方 法
我们从美国疾病控制与预防中心网站获取多重死因数据库，该库囊括了美国所有死亡居民的数据。采用ICD-10编码定义RA及RA-ILD相关性死亡。我们按人口统计资料进行分层，对年龄调整死亡率及其发展趋势进行了研究。
结 果
女性和老年人群的RA及RA-ILD相关死亡率更高（表1）。但是，相比于患有RA的女性死者，患有RA的男性死者的ILD患病率更高(8.7% vs. 13.3%)。RA相关死亡率在印第安人族群中最高，其次是白人族群。相比于白人族群，西班牙裔族群的RA相关死亡率较低，但是RA-ILD相关死亡率却较高（图1）。每百万人口中，RA相关总死亡率从2005年的30.6下降至2018年的22.2。在按性别、种族以及年龄分层的所有亚组中，RA相关死亡率全部下降了，65-84岁亚组的RA-ILD相关死亡率也下降了，但除该亚组以外，所有其他亚组的RA-ILD相关死亡率均保持稳定。
表1 美国2005-2018年按人口统计资料分层的RA及RA-ILD相关年均死亡率
CI – 可信区间；年龄调整死亡率 *；粗死亡率 †；年龄及性别调整死亡率比 ‡ p<0.001, § p<0.001；UR = 不可靠比值 （缺失一年或多年分析数据的比值)
图1 美国2005-2018年不同族群RA（A）及RA-ILD（B）的年龄调整死亡率
结 论
RA相关总死亡率呈下降趋势，但RA-ILD相关死亡率保持稳定（65-84岁亚组除外）。这表明针对RA的治疗措施以及在其他合并症管理上的进步已经改善了RA患者的总体预后，但是对RA-ILD亚组患者的影响仍然有限。
原 文
ABSTRACT
Rationale
The burden of rheumatoid arthritis (RA) and RA-associated interstitial lung disease (RA-ILD) in recent years has not been well characterized.
Objective
In this study, we sought to describe RA and RA-ILD-related mortality rates and trends in the U.S. from 2005-2018, stratified by demographics.
Methods
We used the Multiple Cause of Death Database available through the Centers for
Disease Control and prevention website which contains data of all deceased U.S. residents. RA and RA-ILD-related deaths were identified using ICD-10 codes. We examined the age-adjusted mortality rates and trends stratified by demographics.
Results
RA and RA-ILD-related mortality rates were higher in females and older age groups. However, the prevalence of ILD was higher in male decedents with RA compared to female decedents with RA (13.3% vs. 8.7%). RA-related mortality rates were the highest in Native Americans followed by Whites. Compared to Whites, Hispanics had lower RA-related mortality rates but higher RA-ILD-related mortality rates. Overall RA-related mortality rates per 1,000,000 population decreased from 30.6 in 2005 to 22.2 in 2018. RA-related mortality rates declined in both sex, all races, and all age groups. However, RA-ILD-related mortality rates remained stable in both sex, all races, and all age groups except for ages 65 to 84 years, in which the rates declined.
Conclusions
The overall RA-related mortality rates are decreasing, however, RA-ILD-related mortality rates remain stable except in age groups 65-84 years. This would suggest that therapies for RA and improvement in the management of other comorbidities have improved the overall outcomes in RA patients, but have had limited effect in the subgroup of patients with RA-ILD.
文字来源：楼 剑 黄 慧
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