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Mortality outcomes in pediatric rheumatology in the US

Philip J Hashkes1, Bridget M Wright, Michael S Lauer

  • 1Cleveland Clinic, Cleveland, Ohio, USA. hashkep@ccf.org

Arthritis and Rheumatism
|January 30, 2010
PubMed

Insights

Overall mortality in pediatric rheumatic diseases is not increased, with rates lower than previously reported. Specific conditions like lupus and dermatomyositis showed higher mortality, but overall risk factors were identified.

Area of Science:

  • Rheumatology
  • Pediatric Medicine
  • Epidemiology

Background:

  • Pediatric rheumatic diseases encompass a range of autoimmune and inflammatory conditions affecting children.
  • Understanding mortality patterns is crucial for improving patient outcomes and guiding clinical management.
  • Previous studies have indicated varying mortality rates, necessitating updated data.

Purpose of the Study:

  • To determine mortality rates and causes of death in a large cohort of pediatric rheumatic disease patients in the US.
  • To identify risk factors associated with mortality in this population.
  • To compare current mortality rates with historical data.

Main Methods:

  • Utilized the Indianapolis Pediatric Rheumatology Disease Registry (49,023 newly diagnosed patients, 1992-2001).
  • Matched patient identifiers with the Social Security Death Index (censored March 2005).
  • Confirmed deaths via certificates, physicians, and medical records; analyzed causes of death and calculated standardized mortality ratios (SMRs).

Main Results:

  • Confirmed 110 deaths (0.23%) in 48,885 patients, with a significantly decreased overall SMR (0.65).
  • Elevated SMRs were observed for systemic lupus erythematosus (3.06) and dermatomyositis (2.64), while pain syndromes showed a decreased SMR (0.41).
  • Key mortality risk factors included rheumatic diagnosis, age at diagnosis, sex, and early use of systemic steroids and methotrexate.

Conclusions:

  • The overall mortality rate for pediatric rheumatic diseases in the US is not elevated and is lower than previously reported.
  • While certain conditions like systemic lupus erythematosus and dermatomyositis have increased mortality, the rates are decreasing.
  • Identifying risk factors provides targets for intervention to further reduce mortality in pediatric rheumatic diseases.
Abstract

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