Mortality among Patients with Giant Cell Arteritis: A Large-scale Population-based Cohort Study
Niv Ben-Shabat1,2, Shmuel Tiosano1,2, Ora Shovman1,2
1From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Medicine B, Sheba Medical Center, Tel Hashomer; The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer; Chief Physician's Office, Clalit Health Services, Tel Aviv; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Laboratory of the Mosaics of Autoimmunity, Saint Petersburg University, Saint Petersburg, Russia.
Insights
Giant cell arteritis (GCA) patients experience slightly reduced long-term survival. This increased mortality risk is concentrated in the first two years and over ten years post-diagnosis, particularly for those diagnosed younger than 70.
Area of Science:
- Rheumatology
- Epidemiology
- Gerontology
Background:
- Conflicting results exist regarding mortality in giant cell arteritis (GCA).
- Large population-based studies are needed to clarify GCA's impact on survival.
- Understanding age and sex influences on GCA mortality is crucial.
Purpose of the Study:
- To investigate the association between GCA and all-cause mortality.
- To determine if age at diagnosis and sex modify the mortality risk in GCA patients.
Main Methods:
- Retrospective cohort study using a large health services database.
- Inclusion of 7294 GCA patients and 33,688 age- and sex-matched controls.
- Kaplan-Meier survival analysis and Cox proportional hazard models adjusted for confounders.
Main Results:
- GCA patients had a significantly lower median survival time (13.1 years) compared to controls (14.4 years).
- Increased mortality risk was observed within 2 years (HR 1.14) and over 10 years (HR 1.14) post-diagnosis.
- Patients diagnosed at or before age 70 faced higher mortality risks at both intervals.
Conclusions:
- Giant cell arteritis is associated with a minor decrease in long-term survival.
- Excess mortality in GCA patients occurs in distinct early and late periods after diagnosis.
- Younger age at diagnosis (≤70 years) represents a significant risk factor for increased mortality in GCA.
Objective:
Studies regarding mortality among patients with giant cell arteritis (GCA) have yielded conflicting results. Thus in this large population-based study we aimed to examine whether GCA is associated with increased mortality, and if so, the effect of age at diagnosis and sex on the association.
Methods:
We used the medical database of Clalit Health Services for this retrospective cohort study. Followup was from January 1, 2002, and continued until death or end of followup on September 1, 2018. Incident GCA patients were compared with age- and sex-matched controls. Estimated median survival times were calculated using the Kaplan-Meier method. HR for all-cause mortality were obtained by the Cox proportional hazard model, adjusted for sociodemographic variables and cardiovascular risk factors.
Results:
The study included 7294 patients with GCA and 33,688 controls. The mean age at start of followup was 72.1 ± 9.9 years with 69.2% females. Estimated median survival time was 13.1 years (95% CI 12.6-13.5) in patients with GCA compared with 14.4 years (95% CI 14.1-14.6) in controls (p < 0.001). The multivariate analysis demonstrated increased mortality risk in the first 2 years after diagnosis (HR 1.14, 95% CI 1.04-1.25) and > 10 years after diagnosis (HR 1.14, 95% CI 1.02-1.3). The mortality risk was higher in patients diagnosed at ≤ 70 years of age [HR 1.5 (95% CI 1.14-1.99) 0-2 yrs; HR 1.38 (95% CI 1.1-1.7) > 10 yrs].
Conclusion:
Patients with GCA have a minor decrease in longterm survival compared to age- and sex-matched controls. The seen difference is due to excess mortality in the first 2 years, and > 10 years after diagnosis. Patients diagnosed ≤ 70 years of age are at greater risk.
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