title: The effect of male sex on survival in systemic sclerosis.
abstract: OBJECTIVE
  Systemic sclerosis (SSc) has a female predominance, however, little is understood about the effect of sex on SSc manifestations and survival. The objectives of our study were to evaluate differences in disease manifestations, and survival rates between males and females with SSc.
  
  
  METHODS
  A retrospective cohort study of the Toronto Scleroderma Program was conducted to evaluate sex-based differences in disease manifestations and survival. A relative survival analysis compared SSc survival to the general population.
  
  
  RESULTS
  There were 959 patients (791 females, 168 males) identified, with a female:male ratio of 4.7:1. Males more frequently had diffuse SSc [45% vs 30%, relative risk (RR) 1.44, 95% CI 1.18-1.75] and interstitial lung disease (ILD; 41% vs 33%, RR 1.24, 95% CI 1.01-1.52). There were 324 deaths (65 males, 259 females). Males had increased unadjusted mortality compared to females (HR 1.57, 95% CI 1.19-2.06). In an adjusted model including immunosuppressive use, male sex (HR 1.40, 95% CI 1.06-1.85), ILD (HR 1.58, 95% CI 1.26-1.98), and older age at diagnosis (HR 1.05, 95% CI 1.04-1.06) were independently associated with increased mortality, whereas the limited subtype (HR 0.70, 95% CI 0.49-0.77) and anticentromere antibodies (HR 0.70, 95% CI 0.49-0.98) were independently associated with decreased mortality. Male sex was associated with increased risk of mortality (HR 1.16, p=0.003) in patients with SSc above that observed for males in the general population.
  
  
  CONCLUSIONS
  The differential effect of disease between sexes is small, yet males have decreased survival compared to females with SSc.
authors.affiliation: From the Toronto Scleroderma Program, Mount Sinai Hospital; Division of Rheumatology, Toronto Western Hospital; Department of Medicine; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.H. Hussein, MD, Toronto Scleroderma Program, and the Division of Rheumatology, Mount Sinai Hospital, and the University of Toronto; P. Lee (deceased), MD, FRACP, FRCPC, Mount Sinai Hospital; C. Chau, BMath, CIM, University Health Network, University of Toronto; S.R. Johnson, MD, PhD, FRCPC, Division of Rheumatology, Toronto Western Hospital.
authors.forename: Haseena
authors.initials: H
authors.lastname: Hussein
authors.affiliation: From the Toronto Scleroderma Program, Mount Sinai Hospital; Division of Rheumatology, Toronto Western Hospital; Department of Medicine; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.H. Hussein, MD, Toronto Scleroderma Program, and the Division of Rheumatology, Mount Sinai Hospital, and the University of Toronto; P. Lee (deceased), MD, FRACP, FRCPC, Mount Sinai Hospital; C. Chau, BMath, CIM, University Health Network, University of Toronto; S.R. Johnson, MD, PhD, FRCPC, Division of Rheumatology, Toronto Western Hospital.
authors.forename: Peter
authors.initials: P
authors.lastname: Lee
authors.affiliation: From the Toronto Scleroderma Program, Mount Sinai Hospital; Division of Rheumatology, Toronto Western Hospital; Department of Medicine; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.H. Hussein, MD, Toronto Scleroderma Program, and the Division of Rheumatology, Mount Sinai Hospital, and the University of Toronto; P. Lee (deceased), MD, FRACP, FRCPC, Mount Sinai Hospital; C. Chau, BMath, CIM, University Health Network, University of Toronto; S.R. Johnson, MD, PhD, FRCPC, Division of Rheumatology, Toronto Western Hospital.
authors.forename: Cathy
authors.initials: C
authors.lastname: Chau
authors.affiliation: From the Toronto Scleroderma Program, Mount Sinai Hospital; Division of Rheumatology, Toronto Western Hospital; Department of Medicine; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.H. Hussein, MD, Toronto Scleroderma Program, and the Division of Rheumatology, Mount Sinai Hospital, and the University of Toronto; P. Lee (deceased), MD, FRACP, FRCPC, Mount Sinai Hospital; C. Chau, BMath, CIM, University Health Network, University of Toronto; S.R. Johnson, MD, PhD, FRCPC, Division of Rheumatology, Toronto Western Hospital. Sindhu.Johnson@uhn.ca.
authors.forename: Sindhu R
authors.initials: SR
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D002423:Cause of Death; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality; D053208:Kaplan-Meier Estimate; D017563:Lung Diseases, Interstitial / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis
keywords: MALE SEX; MORTALITY; RENAL CRISIS; SCLERODERMA; SURVIVAL; SYSTEMIC SCLEROSIS