Temporal Trends in Mortality in Patients with Systemic Sclerosis in Public Hospitals Across Mexico from 1998-2017

OBJECTIVE

To investigate national temporal trends over time in mortality rates in patients with systemic sclerosis (SSc) in Mexico between 1998 and 2017.

METHODS

Deaths between 1998 and 2017 were extracted from General Board of Health Information (DGIS) Open Access datasets. 2We identified all persons aged ≥15 years with a diagnosis of SSc (ICD-10 code M34). We calculated the age-standardized mortality rate (ASMR) for SSc and non-SSc (information provided by the National Institute of Statistics, Geography, and Informatics). A Joinpoint regression model was used to determine mortality trends by sex and geographic regions. Annual percentage change (APC) and average APC (AAPC) were calculated using Joinpoint analysis.

RESULTS

From 1998 to 2017, the overall ASMR of SSc increased (AAPC = 2.5%), whereas the ASMR for non-SSc remained stable. By subpopulations, females, and males with SSc had a significant uptrend in the ASMR (APC = 4.6 and 4.4%, respectively), between 1998 and 2008 for the former and between 1998 and 2010 for the later. Females had a non-significant ASMR uptrend between 2008 and 2017 and males a non-significant ASMR decline between 2010 and 2017. Women had a higher SSc-ASMR to non-SSc-ASMR ratio than males. The relative cumulative change between 1998 and 2017 differed between females (78.1%) and males (50.8%), and residents of the Southern region had the largest cumulative change (147.8%).

CONCLUSIONS

SSc mortality rate increased in Mexico between 1998 to 2017, with SSc mortality higher than non-SSc mortality. However, the SSc mortality rate steeply increased in the first ten years but has plateaued in the last 10 years of the study period. Variations by sex and geographic regions were also identified.