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Increased risk of systemic lupus erythematosus in patients with autoimmune haemolytic anaemia: a nationwide population-based cohort study
  1. Han-You Mo1,2,
  2. James Cheng Chung Wei2,3,4,
  3. Xiao-Huan Chen2,5,
  4. Hsin-Hua Chen6,7,8,9,10
  1. 1 Department of Rheumatology, Guilin Medical University Affiliated Hospital, Guilin, Guangxi, China
  2. 2 Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
  3. 3 Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
  4. 4 Graduate Institute of Integrated Medicine, China Medical University, Taichuang, Taiwan
  5. 5 Department of Rheumatology, Guilin Medical University, Guilin, Guangxi, China
  6. 6 Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
  7. 7 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
  8. 8 Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
  9. 9 School of Medicine, National Yang-Ming University, Taipei, Taiwan
  10. 10 Institute of Biomedical Science and Rong Hsing Research Centre for Translational Medicine, Chung Hsing University, Taichung, Taiwan
  1. Correspondence to Dr Hsin-Hua Chen, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; shc5555{at}

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Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterised by immune inflammation.1 Autoimmune haemolytic anaemia (AIHA) is a pathological state in which antibodies attack red blood cells. AIHA and SLE shared genetic and environmental risk factors and pathophysiological mechanisms.2 AIHA is clearly over-represented in patients with SLE and often occurs before a diagnosis of SLE.3 However, at present, studies on the incidence of SLE in patients with AIHA are scarce. Therefore, we explored the correlation between AIHA and SLE risk in a nationwide, population-based, matched cohort study.

In the 2003–2013 Taiwanese National Health Insurance Database, we identified patients newly diagnosed with AIHA between 2005 and 2012 (online supplemental figure S1). We selected age-matched and sex-matched (1:20) non-AIHA cohort from one million representative populations. From this cohort, we further selected a comparison group via propensity-score matching (PSM, 1:2) for age, sex, comorbidities and possible confounders using the greedy algorithm (online supplemental methods). Ultimately, we identified 713 patients with AIHA and 1416 PSM-matched individuals …

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  • Handling editor Josef S Smolen

  • H-YM and JCCW contributed equally.

  • Contributors H-YM and JCCW conceptualised the research and drafted the manuscripts. X-HC interpreted the data and drafted the manuscript. H-HC contributed to the research design, performed data analysis and graph generation and critically revised the manuscript. All authors have read and approved the final manuscript.

  • Funding This work was supported by funding from Chung Shan Medical University Hospital grant number CSH-2018-C-023 and the National Natural Science Foundation of China Grants [81 760 298].

  • Competing interests None declared.

  • Patient and public involvement The requirement for informed consent was waived because personal details were completely anonymised before analysis of data.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Board of Taichung Veterans General Hospital in Taiwan (approval number: CE17100B).

  • Provenance and peer review Not commissioned; externally peer reviewed.