Overall and Sex-specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Meta-analysis

Young Ho Lee; Gwan Gyu Song

doi:10.4078/jrd.2018.25.3.197

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Lee and Song: Overall and Sex-specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Meta-analysis

Original Article

J Rheum Dis 2018;25(3):197-202.

Published online: 31 July 2018

DOI: https://doi.org/10.4078/jrd.2018.25.3.197

Overall and Sex-specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Meta-analysis

Young Ho Lee, Gwan Gyu Song

Department of Rheumatology, Korea University College of Medicine, Seoul, Korea

Corresponding to: Young Ho Lee http://orcid.org/0000-0003-4213-1909 Department of Rheumatology, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. E-mail: lyhcgh@korea.ac.kr

Received 5 April 201814 May 2018 Accepted 30 May 2018

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

This study examined the all-cause and sex-specific standardized mortality ratios (SMRs) in patients with spondyloarthropathy.

Methods

Studies examining the all-cause and/or cause-specific SMRs in patients with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) compared to the general population were surveyed using MEDLINE, EMBASE, and Cochrane databases and manual searches. A meta-analysis of the all-cause and sex-specific SMRs in patients with rheumatic diseases was then performed.

Results

In total, 7 comparisons (5 PsA and 2 AS) from 6 reports met the inclusion criteria. Disease-specific meta-analysis showed that the pooled SMR was 1.299 (95% confidence interval [CI] 1.092∼1.605, p=0.015) for PsA and 1.784 (95% CI 1.576∼2.020, p＜0.001) for AS. Meta-analysis showed that the SMRs of PsA and AS were significantly higher (1.299 to 1.784 times) than those in the general population. The age- and sex-adjusted SMR was highest for AS (1.784), followed by PsA (1.299). Moreover, sex-specific meta-analysis showed that the all-cause SMRs were increased in female and male patients with PsA. On the other hand, mortality increased in male patients with AS (SMR 1.834), whereas there was no significant increase in female patients with AS.

Conclusion

All-cause mortality is higher in patients with PsA and AS compared to the general population. On the other hand, the mortality was higher in males with AS but not in females.

Keywords: Psoriatic arthritis, Ankylosing spondylitis, Mortality, Meta-analysis

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Figure 1.

Study flow chart of the article selection process.

Figure 2.

Meta-analysis of the all-cause standardized mortality ratios in patients with PsA and AS. PsA: psoriatic arthritis, AS: ankylosing spondylitis, SMR: standardized mortality ratio, CI: confidence interval.

Figure 3.

Meta-analysis of the all-cause standardized mortality ratios in male (A) and female (B) patients with PsA and AS. PsA: psoriatic arthritis, AS: ankylosing spondylitis, SMR: standardized mortality ratio, CI: confidence interval.

Table 1.

Characteristics of the individual studies included in the meta-analysis

Study	Country	Disease	Enrollment period	Follow-up period	Patient number	Number of deaths	Overall mortality		Mortality studied	Quality
Study	Country	Disease	Enrollment period	Follow-up period	Patient number	Number of deaths	SMR	95% CI	Mortality studied	Quality
Juneblad, 2016 [11]	Sweden	PsA	1995∼2011	Retrospective study	464	44	1.22	0.89∼1.63	All-cause (male, female)	6
Mok, 2011 [10]	China	PsA	1999∼2008	Retrospective study	778	50	1.59	1.16∼2.03	All-cause (male, female)	6
Buckley, 2010 [9]	UK	PsA	1985∼2007	Retrospective study	453	37	0.82	0.58∼1.13	All-cause (male, female)	6
Ali, 2007 [8]	UK	PsA	1978∼2004	NA	680	106	1.36	1.12∼1.64	All-cause (male, female)	7
Wong, 1997 [7]	UK	PsA	1978∼1993	Median 11.4 years	428	53	1.62	1.21∼2.12	All-cause (male, female)	8
Bakland, 2011 [5]	Norway	AS	1969∼2009	Mean 31.9 years	677	98	1.61	1.29∼1.93	All-cause (male, female)	8
Mok-1, 2011 [10]	China	AS	1999∼2008	Retrospective study	2,154	199	1.87	1.61∼2.13	All-cause (male, female)	6

SMR: standardized mortality ratio, CI: confidence interval, PsA: psoriatic arthritis, AS: ankylosing spondylitis, NA: not available.

Table 2.

Meta-analysis of the all-cause standardized mortality ratios in patients with PsA and AS

Group	Population	Number of studies	SMR	Test of association		Test of heterogeneity
Group	Population	Number of studies	SMR	95% CI	p-value	Model	p-value	I²
All	Overall	7	1.432	1.137∼1.728	＜0.001	R	＜0.001	84.8
	PsA	5	1.299	1.092∼1.605	0.015	R	0.021	65.4
	AS	2	1.784	1.576∼2.020	＜0.001	F	0.273	16.9
Male	Overall	7	1.410	1.132∼1.756	0.002	R	0.003	69.8
	PsA	5	1.245	1.043∼1.485	0.015	F	0.155	39.8
	AS	2	1.834	1.605∼2.095	＜0.001	F	0.230	30.4
Female	Overall	7	1.473	1.245∼1.743	＜0.001	F	0.199	29.9
	PsA	5	1.457	1.134∼1.976	0.004	R	0.075	72.9
	AS	2	1.380	0.807∼2.360	0.240	F	1.000	0

PsA: psoriatic arthritis, AS: ankylosing spondylitis, SMR: standardized mortality ratio, CI: confidence interval, R: random effects model, F: fixed effects model.

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