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FRI0418 Mortality Associated with Systemic Lupus Erythematosus in France: A Multiple Cause-Of-Death Analysis
  1. L. Chiche1,
  2. G. Thomas2,
  3. B. Meunier2,
  4. J. Mancini3,
  5. N. Jourde-Chiche4,
  6. E. Jougla5,
  7. J.-R. Harle1
  1. 1Internal Medicine
  2. 2APHM, CHU la Conception
  3. 3Public Health, APHM la Timone
  4. 4Nephrology, APHM, CHU la Conception, Marseille
  5. 5CEPIDC, INSERM, Paris, France

Abstract

Background Systemic Lupus Erythematosus (SLE) is a chronic auto-immune disease that can be severe and life threatening. The overall mortality rate has improved significantly over the past 50 years but is still high as compared with the general population.

Objectives The aim of the study is to analyze the mortality profile related to SLE in France.

Methods For the 2000-2009 period, data collected in the French Epidemiological Center for the Medical Causes of Death (CépiDc, Inserm) database and corresponding to death certificates of adults (n=1593) on which SLE was listed as an underlying (n=637) or non-underlying cause (n=956) of death were analyzed using multiple cause-of-death analysis. Gender, age, sex-ratio, standardized mortality rates as well as the respective weight and frequency of the various causes of death were assessed, both at national and regional level. The observed/expected death ratio (O/E ratio) was calculated for the main causes of death.

Results Mean age at death was 63.5±17.3 years. Sex-ratio was 3.5 (1238 female and 355 male). The mean standardized mortality rate was 3.2 per 106 people. For SLE as an underlying cause, the main non-underlying causes of death were cardiovascular diseases (49.5%), infectious diseases (24.5%) and renal failure (23.2%). For SLE as a non-underlying cause of death, the most common underlying causes of death were cardiovascular diseases (35.7%), neoplasms (13.9%) and infectious diseases (10.3%). The overall death O/E ratio was >1 for infectious and cardiovascular diseases and renal failure (especially for people <40 years of age for the 2 last causes), but was <1 for neoplams. Digestive neoplasms, hematologic malignancies, and lung neoplasms were the most frequent cancers reported. Considering each type of cancer individually, an O/E ratio of <1 (age and gender-adjusted) was found for lung cancer, digestive neoplasms, and gynecological neoplasms, but not for hematologic malignancies. There were no differences between the Mediterranean area and the rest of France concerning the causes of death. In overseas departments, the standardized mortality rate was higher (10.8/106 people) and the mean age of death was earlier.

Conclusions For the 2000-2009 period, cardiovascular diseases are the most important cause of death associated to SLE in France with a significant excess of mortality compared to general population. It is therefore essential to improve the early identification of SLE patients at high risk for cardiovascular events in order to optimize therapeutic and preventive interventions in this population and improve survival in SLE.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2400

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