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Standardized mortality ratios in systemic sclerosis: a meta-analysis assessing overall and sex- and disease subtype-specific differences

Standardisierte Mortalitätsrate bei systemischer Sklerose: Metaanalyse zur Bestimmung der Gesamt- sowie geschlechts- und krankheitssubtypenspezifischen Unterschiede

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Abstract

Objective

This study aims to evaluate the overall and sex- and illness subtype-specific standardized mortality ratios (SMRs) in patients with systemic sclerosis (SSc).

Methods

We searched and examined studies that compared the overall and sex- and illness subtype-specific SMRs in patients with SSc to those in the general population using MEDLINE, EMBASE, and Cochrane databases (until May 2023). We then conducted a meta-analysis of the overall and sex- and illness subtype-specific SMRs in patients with SSc.

Results

Overall, 29 studies including 30,673 patients with SSc and 5582 deaths met the inclusion criteria. Patients with SSc had a higher overall SMR than that in the general population (SMR: 2.742, 95% confidence interval [CI]: 2.224–3.38091, p < 0.001). The SMR significantly increased in populations from Europe, North America, Asia, and Oceania according to regional stratification. A sex-specific meta-analysis revealed a substantial increase in the SMR in both men and women (SMR: 3.598, 95% CI: 3.097–4.180, p < 0.001; SMR: 2.833, 95% CI: 2.4384–3.292, p < 0.001, respectively) and the mortality rate was higher in men compared to women. A substantial increase in the SMR in diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) was observed in a disease subtype-specific meta-analysis. In addition, the SMR in the dcSSc group was higher than that in the lcSSc group (SMR: 4.726, 95% CI: 3.795–5.885, p < 0.001; SMR: 1.987, 95% CI: 1.586–2.489, p < 0.001, respectively).

Conclusion

Our findings demonstrated that the mortality rate in patients with SSc was 2.74-times greater than that in the general population. The mortality rate was higher in men compared to women. Additionally, compared to patients with lcSSc, those with dcSSc showed much higher fatality rates.

Zusammenfassung

Ziel

Ziel der vorliegenden Studie war es, die Gesamt- sowie geschlechts- und krankheitssubtypenspezifischen standardisierten Mortalitätsraten (SMR) bei Patienten mit systemischer Sklerose (SSc) zu bestimmen.

Methode

Dazu wurden Studien unter Einsatz der Datenbanken MEDLINE, EMBASE und Cochrane (bis Mai 2023) gesucht und ausgewertet, in denen die Gesamt- sowie geschlechts- und krankheitssubtypenspezifischen SMR bei Patienten mit SSc mit denjenigen in der Allgemeinbevölkerung verglichen wurden. Dann wurde eine Metaanalyse in Bezug auf die Gesamt- sowie geschlechts- und krankheitssubtypenspezifischen SMR bei Patienten mit SSc durchgeführt.

Ergebnisse

Die Einschlusskriterien wurden von 29 Studien mit 30.673 SSc-Patienten und 5582 Todesfällen erfüllt. Patienten mit SSc wiesen eine höhere Gesamt-SMR auf als die Allgemeinbevölkerung (SMR: 2,742; 95%-Konfidenzintervall, 95%-KI: 2,224–3,38091; p < 0,001). Die SMR nahm der regionalen Stratifizierung gemäß signifikant in Populationen aus Europa, Nordamerika, Asien und Ozeanien zu. Eine geschlechtsspezifische Metaanalyse ergab einen substanziellen Anstieg der SMR sowohl bei Männern als auch bei Frauen (SMR: 3,598; 95%-KI: 3,097–4,180; p < 0,001 bzw. SMR: 2,833; 95%-KI: 2,4384–3,292; p < 0,001), und die Mortalitätsrate war höher bei Männern als bei Frauen. Ein substanzieller Anstieg der SMR bei diffuser kutaner SSc (dcSSc) und limitierter kutaner SSc (lcSSc) wurde in einer krankheitssubtypenspezifischen Metaanalyse festgestellt. Darüber hinaus war die SMR in der dcSSc-Gruppe höher als in der lcSSc-Gruppe (SMR: 4,726; 95%-KI: 3,795–5,885; p < 0,001 bzw. SMR: 1,987; 95%-KI: 1,586–2,489; p < 0,001).

Schlussfolgerung

Die vorliegenden Ergebnisse zeigen, dass die Mortalitätsrate bei Patienten mit SSc 2,74-mal größer war als in der Allgemeinbevölkerung. Bei Männern war die Mortalitätsrate höher als bei Frauen. Außerdem wiesen im Vergleich zu Patienten mit lcSSc die Patienten mit dcSSc viel höhere Mortalitätsraten auf.

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Authors and Affiliations

  1. Department of Rheumatology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (Republic of)

    Young Ho Lee MD PhD & Gwan Gyu Song

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  1. Young Ho Lee MD PhD
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Correspondence to Young Ho Lee MD PhD.

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Conflict of interest

Y.H. Lee and G.G. Song declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Ulf Müller-Ladner, Bad Nauheim

Uwe Lange, Bad Nauheim

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Lee, Y.H., Song, G.G. Standardized mortality ratios in systemic sclerosis: a meta-analysis assessing overall and sex- and disease subtype-specific differences. Z Rheumatol 83 (Suppl 1), 175–182 (2024). https://doi.org/10.1007/s00393-023-01401-x

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