Background Little is known about mortality in idiopathic inflammatory myopathies (IIM) compared to the general population, especially the risk development since diagnosis. In a recently published study, the 5-, and 10-year mortality was lower for IIM than previously reported, suggesting improved outcomes in recent years.
Objectives To assess the mortality following IIM diagnosis in a nationwide population-based cohort of IIM patients diagnosed 2002–2011 compared to the general population.
Methods We used nationwide fully covering health care registers to identify all individuals who were treated by a rheumatologist, neurologist, or dermatologist for IIM and who had a listing of IIM at ≥two visits within 1–12 months between 2002 and 2011, general population comparators, and death during follow up. We calculated mortality rates with 95% confidence intervals (CI) and compared the mortality in IIM to that in the general population using Cox proportional hazards models adjusted for age, sex, year of diagnosis, and residential area.
Results During a median follow up of 4 years, 228 (31%) of the 733 IIM patients and during a median follow up of 6 years, 888 (12%) of the 7,340 general population comparators died. This corresponded to a crude mortality of 61/1,000 person-years in IIM, and 20/1,000 person-years in the comparators. The cumulative mortality at 1 year after diagnosis was 10% in IIM and 1% in the general population, at 5 years it was 24% in IIM and 7% in general population, and at 10 years the proportion was 31% and 12%. The overall hazard ratio (HR) (95% CI) of death comparing the NPR cohort and its comparator, was 3.5 (3.0–4.0). When restricting the outcome to cardiovascular disease-, cancer-, infection-, or pulmonary disease- specific death we noted increased mortality from all outcomes in IIM compared to the risk in the general population. When we stratified on time since diagnosis we noted an increased absolute and relative risk of death in the first year of diagnosis in particular for pulmonary disease and cancer, whereas cardiovascular mortality was a major cause of death also after 10 years after IIM diagnosis (table).
Conclusions IIM patients are still at increased risk of death. The highest mortality was noted within a year of diagnosis due to pulmonary disease, cancer and cardiovascular disease which calls for extra vigilance with respect to comorbidities during the first year of IIM diagnosis.
Disclosure of Interest None declared