All-cause and cause-specific mortality in patients with giant cell arteritis: a nationwide, population-based cohort study

• Published in: Rheumatology (Oxford, England) Vol. 61; no. 3; pp. 1195 - 1203
• Main Authors: Therkildsen, Philip, Nielsen, Berit Dalsgaard, de Thurah, Annette, Hansen, Ib Tønder, Nørgaard, Mette, Hauge, Ellen-Margrethe
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 02.03.2022
• Subjects: Aged; Cause of Death; Cohort Studies; Denmark - epidemiology; Female; Giant Cell Arteritis - drug therapy; Giant Cell Arteritis - epidemiology; Giant Cell Arteritis - mortality; Glucocorticoids - therapeutic use; Humans; Male; Risk Factors; Denmark; mortality; large-vessel vasculitis; giant cell arteritis; epidemiology; temporal artery biopsy; nationwide register
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keab507

Abstract Objectives To investigate whether GCA is associated with increased all-cause and cause-specific mortality. Methods A nationwide, population-based cohort study in Denmark using medical and administrative registries. GCA cases were defined as patients aged ≥50 years from 1996–2018 with a first-time discharge diagnosis of GCA and ≥3 prescriptions for prednisolone within 6 months following diagnosis. Each GCA patient was matched based on age, sex and calendar time to 10 persons without a history of GCA. Index date was the date for the third prednisolone prescription. We used a pseudo-observation approach to calculate all-cause and cause-specific mortality, adjusted risk differences (RDs) and relative risks (RRs). Results We included 9908 GCA patients and 98 204 persons from the general population. The median time for GCA patients to redeem the third prednisolone prescription was 74 days [interquartile range (IQR: 49–106)]. Among GCA patients, the overall mortality was 6.4% (95% CI: 5.9, 6.9) 1 year after index date and 45% (95% CI: 44, 47) after 10 years. Compared with the reference cohort, adjusted RDs and RRs of deaths in the GCA cohort were 2.2% (95% CI: 1.7, 2.7) and 1.49 (95% CI: 1.36, 1.64) after 1 year, and 2.1% (95% CI: 1.0, 3.3) and 1.03 (95% CI: 1.00, 1.05) 10 years after index date. GCA patients had a higher risk of death due to infectious, endocrine, cardiovascular and gastrointestinal diseases. Conclusions GCA is associated with increased all-cause mortality, particularly within the first year following the diagnosis. Cause-specific mortality indicates that mortality in GCA may in part be due to glucocorticoid-related complications.