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Abstract
Objectives To compare all-cause mortality and causes of death between patients with psoriatic arthritis (PsA) and the general population in Sweden.
Methods Adults with at least one main PsA diagnosis (International Classification of Diseases-10: L40.5/M07.0–M07.3) from outpatient rheumatology/internal medicine departments 2001–2017 were identified from the National Patient Register. Each case was matched to five population comparator-subjects on sex/county/age at the case’s first arthritis diagnosis. Follow-up ran from 1 January 2007, or from first PsA diagnosis thereafter, until death, emigration or 31 December 2018. Mortality was assessed overall, and stratified by sex and duration since diagnosis (diagnosis before/after 1 January 2007), using matched Cox proportional hazard regression (excluding/including adjustments for comorbidity) or Breslow test, as appropriate. Incidence rate ratios (IRR) of death, overall and stratified by sex/duration since diagnosis/age, as well as causes of death in PsA cases and comparator-subjects were also described.
Results All-cause mortality was elevated in PsA (HR: 1.11 (95% CI: 1.07 to 1.16); IRR: 1.18 (95% CI: 1.13 to 1.22)), mainly driven by increased risks in women (HR: 1.23 (95% CI: 1.16 to 1.30)) and cases with longer time since diagnosis (HR: 1.18 (95% CI: 1.12 to 1.25)). IRR of death were significantly increased for all ages except below 40 years, with the numerically highest point-estimates for ages 40–59 years. When adjusted for comorbidity, however, the elevated mortality risk in PsA disappeared. Causes of death were similar among PsA cases/comparator-subjects, with cardiovascular disease and malignancy as the leading causes.
Conclusions Mortality risk in PsA in Sweden was about 10% higher than in the general population, driven by excess comorbidity and with increased risks mainly in women and patients with longer disease duration.
- Arthritis, Psoriatic
- Epidemiology
- Mortality
- Cause of Death
- Sweden
Data availability statement
Data may be obtained from a third party and are not publicly available. The study was conducted using de-identified participant data from various national Swedish administrative and healthcare registers. For further information the corresponding author JKW (johan.81.karlsson@gmail.com) may be contacted.
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Data availability statement
Data may be obtained from a third party and are not publicly available. The study was conducted using de-identified participant data from various national Swedish administrative and healthcare registers. For further information the corresponding author JKW (johan.81.karlsson@gmail.com) may be contacted.
Footnotes
Handling editor Josef S Smolen
Twitter @ValgerdurRos
Contributors SE, DDG, LTHJ, JA and JKW contributed to the conception and design of the study. JKW performed the statistical analyses. All authors contributed to acquisition and interpretation of data. SE and JKW drafted the manuscript. All authors critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript to be published and agree to be accountable for all aspects of the work. JKW is the guarantor for this manuscript.
Funding This study was supported by AbbVie, Amgen, Eli Lilly, Novartis and Pfizer. The sponsors were allowed to comment on the study protocol and were provided with a report of the results, but had no influence on the study design, data collection, data analysis, data interpretation, writing of the report or decision to submit the manuscript. This study was further supported by unrestricted grants from Psoriasisförbundet, Gösta A Karlssons 60-årsfond, Reumatikerförbundet and Skåne University Hospital.
Competing interests SE: Grant/research support from AbbVie, Amgen, Eli Lilly, Novartis and Pfizer (as detailed under Funding statement); Consulting fees from Amgen, Janssen, Novartis and UCB Pharma. DDG: None declared. EK: Speaker’s bureau fees from Amgen, Janssen, Pfizer and UCB Pharma. VS: Speaker’s bureau fees from AbbVie, AstraZeneca and Novartis; Advisory board participation for AbbVie, Galapagos, Janssen, Novartis, Sanofi and UCB Pharma. SW: None declared. UL: None declared. CT: Grant/research support from BMS; Speaker’s bureau fees from AbbVie, BMS, Nordic Drugs, Pfizer and Roche; Advisory board participation for Roche. LTHJ: Speaker’s bureau fees from AbbVie, Janssen and Novartis; Advisory board participation for AbbVie, Eli Lilly, Janssen, Novartis and Pfizer. JA: Grant/research support for the Swedish biologics register ARTIS from AbbVie, BMS, Eli Lilly, Galapagos, Merck, Pfizer, Roche, Samsung Bioepis, Sanofi and UCB Pharma. JKW: Grant/research support from AbbVie, Amgen, Eli Lilly, Novartis and Pfizer (as detailed under Funding statement); Speaker′s bureau fees from AbbVie and Amgen.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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