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Increased Mortality in Asians With Systemic Sclerosis in Northern California

OBJECTIVE: The objective of this study is to evaluate racial/ethnic differences in disease manifestations and survival in a US cohort of patients with systemic sclerosis (SSc), with a focus on Asian patients. METHODS: A retrospective cohort study was conducted among Kaiser Permanente Northern Califo...

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Autores principales: Chung, Melody P., Dontsi, Makdine, Postlethwaite, Debbie, Kesh, Sumana, Simard, Julia F., Fiorentino, David, Zaba, Lisa C., Chung, Lorinda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164633/
https://www.ncbi.nlm.nih.gov/pubmed/32198914
http://dx.doi.org/10.1002/acr2.11126
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author Chung, Melody P.
Dontsi, Makdine
Postlethwaite, Debbie
Kesh, Sumana
Simard, Julia F.
Fiorentino, David
Zaba, Lisa C.
Chung, Lorinda
author_facet Chung, Melody P.
Dontsi, Makdine
Postlethwaite, Debbie
Kesh, Sumana
Simard, Julia F.
Fiorentino, David
Zaba, Lisa C.
Chung, Lorinda
author_sort Chung, Melody P.
collection PubMed
description OBJECTIVE: The objective of this study is to evaluate racial/ethnic differences in disease manifestations and survival in a US cohort of patients with systemic sclerosis (SSc), with a focus on Asian patients. METHODS: A retrospective cohort study was conducted among Kaiser Permanente Northern California adults with an incident SSc diagnosis by a rheumatologist from 2007 to 2016, confirmed by a chart review to fulfill 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. Self‐reported race/ethnicity was categorized as non‐Hispanic white, Asian, Hispanic, and black. Disease manifestations and survival were compared, using white patients as the reference. RESULTS: A total of 609 patients with incident SSc were identified: 89% were women, and 81% had limited cutaneous SSc, with a mean age at diagnosis of 55.4 ± 14.8 years. The racial/ethnic distribution was 51% non‐Hispanic white (n = 310), 25% Hispanic (n = 154), 16% Asian (n = 96), and 8% black (n = 49). Compared with white patients, black patients had a greater prevalence of diffuse disease (14.5% vs. 44.9%; P < 0.001), and Asians had higher rates of anti‐U1‐RNP antibodies (32.1% vs. 11.9%; P = 0.005). Nine‐year overall survival rates following SSc diagnosis were lower in Asian (52.3%), black (52.2%), and Hispanic patients (68.2%) compared with white patients (75.8%). Pulmonary hypertension and infections were the leading causes of death in Asian patients. Asian race was associated with higher mortality on univariable (hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.08‐2.99]; P = 0.020) and multivariable analyses (HR 1.80 [95% CI 0.99‐3.16]; P = 0.047) when adjusting for age, sex, body mass index, cutaneous subtype, smoking status, interstitial lung disease, pulmonary hypertension, renal crisis, and malabsorption syndrome. CONCLUSION: Asian patients with SSc in this US cohort had increased mortality compared with white patients. These patients warrant close monitoring for disease progression.
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spelling pubmed-71646332020-04-20 Increased Mortality in Asians With Systemic Sclerosis in Northern California Chung, Melody P. Dontsi, Makdine Postlethwaite, Debbie Kesh, Sumana Simard, Julia F. Fiorentino, David Zaba, Lisa C. Chung, Lorinda ACR Open Rheumatol Original Articles OBJECTIVE: The objective of this study is to evaluate racial/ethnic differences in disease manifestations and survival in a US cohort of patients with systemic sclerosis (SSc), with a focus on Asian patients. METHODS: A retrospective cohort study was conducted among Kaiser Permanente Northern California adults with an incident SSc diagnosis by a rheumatologist from 2007 to 2016, confirmed by a chart review to fulfill 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. Self‐reported race/ethnicity was categorized as non‐Hispanic white, Asian, Hispanic, and black. Disease manifestations and survival were compared, using white patients as the reference. RESULTS: A total of 609 patients with incident SSc were identified: 89% were women, and 81% had limited cutaneous SSc, with a mean age at diagnosis of 55.4 ± 14.8 years. The racial/ethnic distribution was 51% non‐Hispanic white (n = 310), 25% Hispanic (n = 154), 16% Asian (n = 96), and 8% black (n = 49). Compared with white patients, black patients had a greater prevalence of diffuse disease (14.5% vs. 44.9%; P < 0.001), and Asians had higher rates of anti‐U1‐RNP antibodies (32.1% vs. 11.9%; P = 0.005). Nine‐year overall survival rates following SSc diagnosis were lower in Asian (52.3%), black (52.2%), and Hispanic patients (68.2%) compared with white patients (75.8%). Pulmonary hypertension and infections were the leading causes of death in Asian patients. Asian race was associated with higher mortality on univariable (hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.08‐2.99]; P = 0.020) and multivariable analyses (HR 1.80 [95% CI 0.99‐3.16]; P = 0.047) when adjusting for age, sex, body mass index, cutaneous subtype, smoking status, interstitial lung disease, pulmonary hypertension, renal crisis, and malabsorption syndrome. CONCLUSION: Asian patients with SSc in this US cohort had increased mortality compared with white patients. These patients warrant close monitoring for disease progression. John Wiley and Sons Inc. 2020-03-21 /pmc/articles/PMC7164633/ /pubmed/32198914 http://dx.doi.org/10.1002/acr2.11126 Text en © 2020 The Authors. ACR Open Rheumatology published by Wiley Periodicals Inc on behalf of American College of Rheumatology. This article has been contributed to by US Government employees and their work is in the public domain in the USA. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Chung, Melody P.
Dontsi, Makdine
Postlethwaite, Debbie
Kesh, Sumana
Simard, Julia F.
Fiorentino, David
Zaba, Lisa C.
Chung, Lorinda
Increased Mortality in Asians With Systemic Sclerosis in Northern California
title Increased Mortality in Asians With Systemic Sclerosis in Northern California
title_full Increased Mortality in Asians With Systemic Sclerosis in Northern California
title_fullStr Increased Mortality in Asians With Systemic Sclerosis in Northern California
title_full_unstemmed Increased Mortality in Asians With Systemic Sclerosis in Northern California
title_short Increased Mortality in Asians With Systemic Sclerosis in Northern California
title_sort increased mortality in asians with systemic sclerosis in northern california
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164633/
https://www.ncbi.nlm.nih.gov/pubmed/32198914
http://dx.doi.org/10.1002/acr2.11126
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