Effect of renal disease on the standardized mortality ratio and life expectancy of patients with systemic lupus erythematosus.

OBJECTIVE: To study the effect of renal disease on the standardized mortality ratio (SMR) and life expectancy of patients with systemic lupus erythematosus (SLE). METHODS: Patients whose diagnosis met ≥4 American College of Rheumatology criteria for SLE were longitudinally followed up from 1995 to 2011. The cumulative survival rate, SMR, and life expectancy were calculated, and the effect of renal involvement, histologic class of lupus nephritis, renal damage, and end-stage renal disease (ESRD) on these parameters was evaluated. RESULTS: Of the 694 SLE patients studied, 368 (53%) had renal disease, and the distribution of histologic classes (among 285 patients) was class I (1%), class II (6%), class III (19%), class IV (47%), class III/IV + class V (10%), and class V (16%). Renal damage was present in 79 patients (11%), and 24 (3%) developed ESRD. The age- and sex-adjusted hazard ratios (HRs) of mortality in SLE patients with renal disease, those with renal damage, and those with ESRD, as compared to those without, were 2.23 (95% confidence interval [95% CI] 1.29-3.85), 3.59 (95% CI 2.20-5.87), and 9.20 (95% CI 4.92-17.2), respectively. Proliferative lupus nephritis (adjusted HR 2.28, 95% CI 1.22-4.24), but not the pure membranous type (adjusted HR 1.09, 95% CI 0.38-3.14), was associated with a significant increase in mortality. The age- and sex-adjusted SMRs of SLE patients without renal involvement, those with lupus nephritis, those with proliferative nephritis, those with pure membranous nephritis, those with renal damage, and those with ESRD were 4.8 (95% CI 2.8-7.5), 9.0 (95% CI 6.7-11.9), 9.8 (95% CI 6.5-14.1), 6.1 (95% CI 2.0-14.1), 14.0 (95% CI 9.1-20.5), and 63.1 (95% CI 33.6-108.0), respectively. The life expectancy of SLE patients with renal disease and those with renal damage was reduced by 15.1 years and 23.7 years, respectively, compared to the general population. CONCLUSION: The presence of renal disease, in particular proliferative nephritis causing renal insufficiency, significantly reduces the survival and life expectancy of SLE patients.

Decomposing the widening suicide gender gap: an experience in Taipei City, Taiwan.

BACKGROUND: There has been a widening suicide gender gap in Taiwan in the past decade. This study aimed to examine the contributions of changing incidence patterns of suicidal behavior and case fatalities of different suicide methods in quantitatively explaining the male excess in suicide rates and the associated changes in gender ratio of suicide in Taipei City from 2004 to 2006. METHODS: A decompositional method was used to quantify the contributions of age, method-specific case fatality, and attempt incidence to male excess in suicide rates. Our aim is to examine the male excess in suicide rate by decomposing the difference (i.e., male minus female) and widening gender ratio (i.e., male to female) during the study period, respectively. RESULTS: Charcoal burning suicide replaced hanging as the most common method of suicide in 2006. Its percentage of contribution for the male excess in suicide rate (i.e., male minus female) increased from 36.3% in 2004 to 45.1% in 2006 whereas poisoning from solid and liquid poisoning reduced from 7.7% to 4.9% for the same period. Also, the widening suicide gender ratio was mostly due to the increased incidence of attempts of three highly lethal methods of suicide among men: charcoal burning (59.5%), hanging (38.6%), and jumping from a height (35.6%). The disproportionate increase in attempt incidence especially for the methods of charcoal burning and hanging among 40-59 year-old men contributed most significantly to the widened suicide gender gap. LIMITATIONS: Although accessibility to emergency services in major hospitals is good, it is to be expected that there are an unknown number of underreported of suicide attempts which might affect the results. Also, we have selected only age-, gender- and method-specific case fatality and incidence of suicide attempt to explain the male excess in suicide rates. Some other factors, for example, urban and rural region which might be related to the gender ratio, but have not been examined in this study. CONCLUSIONS: Suicide attempt incidences in males and females have increased considerably in the period 2004-2006. As males especially those 40-59 years old are drawn to use more lethal methods of suicide (i.e. charcoal burning and jumping), the excessive male suicide rate and the suicide gender ratio continues to increase even though the gender ratio of attempt incidence remains the same.

A decompositional analysis of the relative contribution of age, sex and methods of suicide to the changing patterns of suicide in Taipei City, 2004-2006.

BACKGROUND: Taipei has seen a substantial increase in suicide rates during the past decade, with a significant rise between 2004 and 2006, the time of this study period. METHODS: A decompositional analytic method was used to quantify the relative contributions of age, sex and case fatality of methods to attempts and suicides. RESULTS: From 2004 to 2006, the rate of fatal and non-fatal suicide attempts combined for population aged 15 years or above in Taipei increased by 37.3%, while the suicide rate increased by 29.2%. Three factors in these analyses contributed to the increase in suicide rates: (1) an increase in number of attempts, (2) a greater proportion of men among fatal and non-fatal attempts and (3) an increase in the use of a lethal method-burning of charcoal to produce carbon monoxide. The authors estimated that 74.5% and 25.6% among men and women, respectively, of the overall increased suicide mortality were attributable to increased 'charcoal burning suicides.' CONCLUSIONS: The rise in suicide rate reflected an increase in attempts and an influx of working-age men joining the pool of people attempting suicide. The much larger size of the attempter pool had the effect of reducing the case fatality even as the suicide rate climbed. The increase in the number of suicide attempts and the rise in the suicide rate were age-, sex-, and method-specific. These results strongly support the concept that reducing the total number of attempts is a central element to curbing suicides.