Original articleA meta-analysis of mortality in rheumatic diseasesMortalidad en las enfermedades reumáticas: un metaanálisis
Introduction
Mortality is a reliable indicator of illness severity.1 Rheumatic diseases are frequent chronic diseases with a great burden from disability and complications that ultimately lead to large losses of quality of life and cumbersome dependency, with demonstrated worse quality of life than other more serious diseases2; albeit they are considered benign diseases as a whole, because they are perceived to have a low mortality. Nevertheless, some rheumatic diseases may be mortal, especially those under the category of inflammatory diseases,3, 4 and others may seem less deadly than they actually are. The recognition of the gradient of death risk among rheumatic diseases and of a decreased life expectancy in general, may subsequently lead to an acknowledgement of rheumatic diseases as relevant ones, with implications in health policies as well as in research budgets; despite the fact that those who manage rheumatic diseases, and rheumatic patients in general, find some very common health states in these diseases worse than death.5
An adequate risk assessment of patients during follow-up can help rheumatologist to improve the management in this rheumatic diseases, including an assessment of death risk, as well as of predictors of such risk.
SMRs are calculated as the ratio of deaths observed in a cohort to those expected in a group of the same size from the general population in the same area and standardized for age and sex of the individuals in the study cohort. Current literature reporting mortality in rheumatic diseases varies widely, and therefore an accurate and weighted analysis of the SMR is of importance. The objective of this systematic review and meta-analysis of published data is to provide an accurate overview of the current risk of mortality in rheumatic diseases.
Section snippets
Methods
We conducted a systematic review and meta-analysis by adapting the procedures of the Cochrane Collaboration (http://www.cochrane.org/training/cochrane-handbook) to a small local team. The findings are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement9 and MOOSE.10
Results
The electronic searches yielded 3526 articles (2121 from PubMed, 1331 from EMBASE, and 74 from Cochrane Library), in all 2776 after removing duplicates, plus 38 abstracts from congresses. The selection by title and abstract left 132 articles plus 7 abstracts for detailed review. Only 32 studies met the complete set of selection criteria and were finally included in the review. Many studies were excluded for not providing the SMR or because the quality was not high enough. Fig. 1 shows the flow
Discussion
We have performed a systematic review and meta-analysis on the standardized mortality in rheumatic diseases. The major result is that mortality is generally increased, especially in inflammatory conditions, and it is supported by moderate to high quality cohort studies. The causes of death in our review actually match those of the general population, where cardiovascular events and cancer are the most frequent causes, but notably, infections and respiratory complications of the underlying
Conclusions
The major result is that mortality is generally increased, especially in inflammatory conditions, and it is supported by moderate to high quality cohort studies. The causes of death in our review actually match those of the general population, where cardiovascular events and cancer are the most frequent causes, but notably, infections and respiratory complications of the underlying inflammatory diseases are actually the causes related to an excess mortality in the diseases of interest.
Based on
Ethical disclosures
Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this investigation.
Confidentiality of Data. The authors declare that no patient data appears in this article.
Right to privacy and informed consent. The authors declare that no patient data appears in this article.
Funding sources
This work was partially supported by the RETICS Program, RD08/0075 (RIER), from Instituto de Salud Carlos III (ISCIII), within the VI Plan Nacional de I+D+I 2008–2011 (FEDER).
Conflicts of interest
All authors declare no conflicts of interest.
Acknowledgment
We would like to thank Research Unit of Sociedad Española de Reumatología (Madrid, Spain) for the collaboration in this manuscript.
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