Background Ankylosing spondylitis (AS) is a chronic inflammatory joint disease that can lead to chronic pain in the axial and peripheral joints and to functional impairments. AS is a systemic disease that can cause extraarticular manifestations which could participate to excess mortality. The aim of the study is to describe characteristics of deaths for which AS was mentioned on the death certificate as either the underlying cause or anywhere on the death certificate and to analyze trends in AS related mortality from 1969 to 2009 in France.
Methods Data were obtained from the Centre of Epidemiology on the Medical Causes of Death (CépiDc) for individuals aged 18 years and over died in France. Owing to implementation of International Classification of Diseases (ICD) 8, ICD-9 and ICD-10 for recording causes of deaths, three separate periods were analyzed (1969-78; 1979–99 and 2000–09). Initial, terminal and associated causes of deaths were analyzed. Initial Causes of deaths were compared with deaths of French general population in the same periods (CIM9 and 10) using Standard Mortality Ratio (SMR) adjusted for age and sex and mortality rate
Results In the global period (1969-2009), AS appeared in 2942 deaths certificates, 2292 men (mean age of death 68,7 years) and 650 women (mean age of 75,8), 601 between 1969-78 (ICD8), 1471 between 1979-1999 (ICD9) and 867 between 2000 and 2009 (ICD10). While mortality rate decreases in the population since 1979, mortality rate of AS remains stable. The number of deaths with AS on the death certificates is increasing due to change of ICD and increase of diagnosis. AS is mentioned as initial cause in 38% in 1969-1978, 33% in 1979-1999 and 5% in 2000-2009. Apart from AS, most frequent initial causes are diseases of the circulatory system (28,5% in ICD8, 23,1% in ICD9 and 26,5% in ICD10 and neoplasms (7,8%, 10,2% and 16,3%). SMR adjusted for age and sex in recent period (2000-2009) are 2,09 (IC 1,45-2,91) for infections, 1,65 (1,31-2,06) for respiratory diseases, 1,9 (1,57-2,29) for external causes and 0,42 (0,35-0,5) for cancers.
Conclusions The manner of death coding varies according to ICD. Our study is the first to analyze AS data from deaths certificate in France. There is overmortality from respiratory system, infectious diseases and external cause of death in AS, conversely, AS patients appear to die less frequently of cancer than the general population.
Disclosure of Interest None declared