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Appendicitis is associated with an increased risk of systemic lupus erythematosus: a nationwide, population-based, case–control study

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Abstract

Objective

To examine the association between appendicitis and the risk of systemic lupus erythematosus (SLE).

Methods

Using claims data from the 2003–2013 Taiwanese National Health Insurance Research Database, we selected 6054 patients with newly diagnosed SLE from 2007 to 2012 and 36,324 age-, sex- and year of SLE diagnosis date-matched (1:6) non-SLE controls. After controlling for potential confounders, a multivariable conditional logistic regression model was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (CI) for the association of appendicitis history with SLE. Sensitivity analyses were conducted using various definitions of appendicitis. Subgroup analyses were conducted to examine possible modification effects by age, gender, level of urbanization, income and Charlson Comorbidity Index (CCI).

Results

The average age of patients was 38 years old in both groups. The proportion of females was 86.5%. 75 (1.2%) of SLE cases and 205 (0.6%) of non-SLE controls had appendicitis history before the index date. After adjusting for potential confounding factors, appendicitis was associated with a higher risk of SLE (aOR, 1.84; 95% CI, 1.34–2.52), and such association remained robust after variation of appendicitis definition. No significant modification effects were found for the association between appendicitis and SLE by age, gender, urbanization level, income and CCI.

Conclusion

This nationwide, population-based case–control study demonstrates an association between appendicitis and incident SLE. Lack of individual smoking status is a major limitation.

Key Points

• Appendicitis was significantly associated with an increased risk of SLE.

• Such association remained robust using various definitions of appendicitis.

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Data availability

The data of National Health Insurance Research Database (NHIRD) was released from Taiwan National Health Insurance (NHI) Bureau. For “Personal Information Protection Act”, the data cannot be made public.

Abbreviations

SLE:

Systemic lupus erythematosus

NHI:

National Health Insurance

NHIRD:

National Health Insurance Research Database

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

LHID 2000:

Longitudinal Health Insurance Database 2000

BNHI:

Bureau of NHI

CCI:

Charlson comorbidity index

ORs:

Odds ratios

CIs:

Confidence intervals

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Acknowledgements

The authors thank the Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan, ROC, for assistance with statistical analyses. This study was conducted with data from the National Health Insurance Research Database, provided by the Bureau of National Health Insurance, Department of Health. The data of this original article has data has been presented previously at Arthritis Rheumatol. 2022 (https://acrabstracts.org/abstract/association-between-appendicitis-and-the-risk-of-systemic-lupus-erythematosus-a-population-based-case-control-study/) [56].

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Authors and Affiliations

  1. Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, ROC

    Yun-Wen Chen, Shih-Ping Lin & Hsin-Hua Chen

  2. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, ROC

    Yun-Wen Chen & Hsin-Hua Chen

  3. Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan

    Yun-Wen Chen, Shih-Ping Lin & Hsin-Hua Chen

  4. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Po-Ke Hsu

  5. Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan

    Po-Ke Hsu

  6. Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Shih-Ping Lin

  7. School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan

    Hsin-Hua Chen

  8. Department of Industrial Engineering and Enterprise Information, Tunghai University, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, ROC

    Hsin-Hua Chen

  9. Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Big Data Center, National Chung Hsin University, Taichung, Taiwan

    Hsin-Hua Chen

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Contributions

Conceptualization: H.-H.C. Data curation: H.-H.C. Formal analysis: Y.-W.C., P.-K.H., and H.-H.C. Funding acquisition: not applicable. Investigation: Y.-W.C., P.-K.H., and H.-H.C. Methodology: H.-H.C. Project administration: H.-H.C. Resources: H.-H.C. Software: H.-H.C. Supervision: H.-H.C. Validation: Y.-W.C., P.-K.H., and H.-H.C. Visualization: Y.-W.C., and H.-H.C. Writing—original draft preparation: Y.-W.C., and P.-K.H. Writing—review and editing: H.-H.C. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Hsin-Hua Chen.

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This study was approved by the Institutional Review Board of Taichung Veterans General Hospital (number TCVGH CE14149B-1).

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Patients’ data were anonymized. For that reason, informed consent was not required.

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Chen, YW., Hsu, PK., Lin, SP. et al. Appendicitis is associated with an increased risk of systemic lupus erythematosus: a nationwide, population-based, case–control study. Clin Rheumatol 42, 1783–1791 (2023). https://doi.org/10.1007/s10067-023-06585-w

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