title: Onset age affects mortality and renal outcome of female systemic lupus erythematosus patients: a nationwide population-based study in Taiwan.
abstract: OBJECTIVE
  The objective of this study was to investigate the impact of disease onset age on mortality and renal survival in female SLE patients.
  
  
  METHODS
  This nationwide, population-based, retrospective cohort study used data from the National Health Insurance Research Database of Taiwan. Female patients newly diagnosed with SLE from 2001 to 2004 were identified as the study cohort. A non-SLE group was matched for age, sex and initial diagnosis date (index date) as the comparison cohort. Co-morbidities, mortality rates and end-stage renal disease (ESRD) incidences were compared among SLE patients of different onset age. Hazard ratios with a 95% CI were determined by the Cox proportional hazard model to quantify the mortality rates and ESRD incidences. Juvenile-onset, adult-onset and late-onset SLE patients were categorized according to disease onset age: <18, 18-50 and >50 years old.
  
  
  RESULTS
  In total, 513 juvenile-onset, 3076 adult-onset and 764 late-onset SLE patients were identified. Compared with non-SLE controls, the hazard ratios of mortality were 6.49 (95% CI 3.73, 11.32, P < 0.001) for juvenile-onset, 1.75 (95% CI 1.47, 2.08, P < 0.001) for adult-onset and 3.44 (95% CI 2.76, 4.28, P < 0.001) for late-onset SLE patients. The hazard ratios of incident ESRD were 20.28 (95% CI 12.79, 32.15, P < 0.001) for adult-onset lupus patients and 1.99 (95% CI 1.36, 2.93, P < 0.001) for late-onset patients.
  
  
  CONCLUSIONS
  Female patients with late-onset SLE carried a higher risk of mortality than those with adult-onset disease in the presence of co-morbidities. Juvenile-onset SLE patients were at greatest risk of mortality, which is probably due to disease severity.
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Blvd, Sec. 4, Taichung 40705, Taiwan. dychen@vghtc.gov.tw.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Chen
authors.forename: Ching-Heng
authors.initials: CH
authors.lastname: Lin
authors.forename: Hsin-Hua
authors.initials: HH
authors.lastname: Chen
authors.forename: Shih-Ni
authors.initials: SN
authors.lastname: Chang
authors.forename: Tsu-Yi
authors.initials: TY
authors.lastname: Hsieh
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Hung
authors.forename: Chia-Wei
authors.initials: CW
authors.lastname: Hsieh
authors.forename: Kuo-Lung
authors.initials: KL
authors.lastname: Lai
authors.forename: Joung-Liang
authors.initials: JL
authors.lastname: Lan
authors.forename: Der-Yuan
authors.initials: DY
authors.lastname: Chen
authors.forename: Tsuo-Hung
authors.initials: TH
authors.lastname: Lan
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000401:mortality*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: age; co-morbidities; end-stage renal disease; mortality; systemic lupus erythematosus