Introduction
Methods
Population and data
Exposure cohort (and ICD code1)
| ORLS1 | ORLS2 | England |
---|---|---|---|
Total (% female) | Total (% female) | Total (% female) | |
Addison's disease (255.4) | 489 (64) | 624 (60) | 10,257 (60) |
Ankylosing spondylitis (720) | 976 (30) | 991 (29) | 2,2001 (29) |
Autoimmune haemolytic anaemia (283) | 421 (55) | 377 (59) | 7,854 (55) |
Chronic active hepatitis (571.4) | 431 (61) | 209 (71) | 4512 (70) |
Coeliac disease (579.0) | 1,722 (61) | 2,324 (66) | 48,239 (66) |
Dermatomyositis, polymyositis (710.3,710.4) | 328 (63) | 268 (70) | 6,002 (63) |
Diabetes mellitus under 30 (250) | 4,950 (47) | 4,410 (48) | 79,581 (48) |
Goodpasture's syndrome (446.2) | 76 (53) | 53 (43) | 999 (45) |
Hashimoto's thyroiditis (245) | 524 (87) | 384 (90) | 8,573 (88) |
Idiopathic thrombocytopenia purpura (287.3) | 779 (54) | 1,221 (57) | 25,984 (55) |
Multiple sclerosis (340) | 3,823 (66) | 4,106 (68) | 81,950 (68) |
Myasthenia gravis (358) | 379 (63) | 420 (57) | 10,024 (51) |
Myxoedema (244) | 6,738 (82) | 23,456 (81) | 63,0354 (81) |
Pemphigus, pemphigoid (694.4,694.5) | 537 (57) | 492 (57) | 11,480 (57) |
Pernicious anaemia (281) | 4,131 (63) | 1,457 (70) | 47,092 (68) |
Polyarteritis nodosa (446) | 298 (42) | 84 (42) | 2,088 (43) |
Primary biliary cirrhosis (571.6) | 359 (77) | 367 (83) | 9,060 (85) |
Psoriasis (696.0,696.1,696.8,696.9) | 3,910 (52) | 3,365 (48) | 85,358 (48) |
Rheumatoid arthritis (714) | 14,231 (73) | 11,241 (72) | 268,005 (71) |
Scleroderma (710.1) | 363 (80) | 542 (85) | 11,643 (82) |
Sjogren's syndrome (710.2) | 165 (86) | 446 (89) | 12,680 (89) |
Systemic lupus erythematosus (710.0) | 594 (86) | 997 (87) | 23,544 (87) |
Thyrotoxicosis (242) | 5,503 (81) | 3,986 (89) | 91,913 (79) |
Dataset (years) | ||||||
---|---|---|---|---|---|---|
Immune-mediated disease (ICD code3) | ORLS1 (1963 to 1998) Rate ratio (95% CI) P-value | ORLS2 (1999 to 2008) Rate ratio (95% CI) P-value | England (1999 to 2008) Rate ratio (95% CI) P-value | |||
Addison's disease (255.4) | 1.49 (0.79 to 2.55) | 0.20 | 2.96 (1.53 to 5.20) | < 0.001 | 2.15 (1.86 to 2.47) | < 0.001 |
Ankylosing spondylitis (720) | 1.35 (0.80 to 2.13) | 0.26 | 1.18 (0.56 to 2.17) | 0.73 | 1.93 (1.74 to 2.14) | < 0.001 |
Autoimmune haemolytic anaemia (283) | 2.83 (1.62 to 4.60) | <0.001 | 3.64 (2.11 to 5.85) | <0.001 | 3.83 (3.43 to 4.25) | < 0.001 |
Chronic active hepatitis (571.4) | 2.24 (1.25 to 3.70) | 0.003 | 3.99 (1.46 to 8.72) | 0.001 | 2.04 (1.65 to 2.50) | <0.001 |
Coeliac disease (579.0) | 1.35 (0.89 to 1.97) | 0.21 | 1.36 (0.87 to 2.03) | 0.17 | 1.21 (1.11 to 1.33) | <0.001 |
Dermatomyositis, polymyositis (710.3,710.4) | 1.98 (0.99 to 3.55) | 0.04 | 2.90 (1.16 to 5.98) | 0.009 | 3.04 (2.60 to 3.54) | <0.001 |
Diabetes mellitus under 30 (250) | 2.13 (1.33 to 3.26) | 0.001 | 3.22 (1.79 to 5.54) | <0.001 | 2.58 (2.22 to 2.98) | <0.001 |
Goodpasture's syndrome (446.2) | 2.29 (0.28 to 8.28) | 0.50 | 6.89 (1.87 to 17.7) | <0.001 | 2.78 (1.78 to 4.14) | <0.001 |
Hashimoto's thyroiditis (245) | 0.89 (0.38 to 1.75) | 0.87 | 0.91 (0.19 to 2.67) | 0.91 | 1.41 (1.15 to 1.72) | 0.001 |
Idiopathic thrombocytopenia purpura (287.3) | 2.04 (0.93 to 3.88) | 0.05 | 1.58 (0.97 to 2.42) | 0.05 | 2.09 (1.90 to 2.29) | <0.001 |
Multiple sclerosis (340) | 2.24 (1.83 to 2.72) | <0.001 | 2.52 (2.00 to 3.13) | <0.001 | 2.14 (2.03 to 2.26) | <0.001 |
Myasthenia gravis (358) | 2.04 (1.09 to 3.49) | 0.02 | 2.34 (1.24 to 4.01) | 0.003 | 2.26 (2.00 to 2.54) | <0.001 |
Myxoedema (244) | 1.47 (1.27 to 1.70) | <0.001 | 1.36 (1.22 to 1.52) | <0.001 | 1.30 (1.27 to 1.33) | <0.001 |
Pemphigus, pemphigoid (694.4,694.5) | 2.69 (1.90 to 3.70) | <0.001 | 3.28 (2.07 to 4.94) | < 0.001 | 2.22 (2.00 to 2.45) | <0.001 |
Pernicious anaemia (281) | 1.20 (0.99 to 1.44) | 0.06 | 1.44 (0.97 to 2.07) | 0.06 | 1.36 (1.27 to 1.45) | <0.001 |
Polyarteritis nodosa (446) | 2.88 (1.70 to 4.55) | <0.001 | 4.36 (0.90 to 12.8) | 0.03 | 3.53 (2.76 to 4.44) | <0.001 |
Primary biliary cirrhosis (571.6) | 1.29 (0.52 to 2.67) | 0.64 | 2.76 (1.37 to 4.95) | 0.001 | 1.49 (1.26 to 1.74) | <0.001 |
Psoriasis (696.0,696.1,696.8,696.9) | 1.62 (1.32 to 1.98) | <0.001 | 1.65 (1.23 to 2.17) | <0.001 | 1.66 (1.57 to 1.75) | <0.001 |
Rheumatoid arthritis (714) | 1.45 (1.31 to 1.60) | <0.001 | 1.57 (1.37 to 1.79) | <0.001 | 1.75 (1.70 to 1.80) | <0.001 |
Scleroderma (710.1) | 2.16 (0.99 to 4.10) | 0.03 | 1.53 (0.70 to 2.91) | 0.29 | 1.97 (1.73 to 2.23) | <0.001 |
Sjogren's syndrome (710.2) | 2.85 (1.37 to 5.25) | 0.001 | 1.91 (1.02 to 3.28) | 0.03 | 2.02 (1.80 to 2.26) | <0.001 |
Systemic lupus erythematosus (710.0) | 3.61 (2.36 to 5.31) | <0.001 | 4.60 (3.19 to 6.43) | <0.001 | 3.71 (3.43 to 4.02) | <0.001 |
Thyrotoxicosis (242) | 1.14 (0.95 to 1.36) | 0.14 | 1.56 (1.23 to 1.95) | <0.001 | 1.34 (1.27 to 1.42) | <0.001 |
Statistical methods
Results
Males and females
Short (0 to 90 days) and long-term (91+ days) associations with VTE
Exposure, time between exposure and VTE (days) | ORLS1 | ORLS2 | England | ||||||
---|---|---|---|---|---|---|---|---|---|
Obs | Exp | RR1 (95% CI) | Obs | Exp | RR1 (95% CI) | Obs | Exp | RR1 (95% CI) | |
MS 0 to 90 | 10 | 8.1 | 1.25 (0.59 to 2.31) | 17 | 6.7 | 2.64 (1.51 to 4.33) | 212 | 112 | 1.95 (1.69 to 2.24) |
91+ | 96 | 43.7 | 2.23 (1.80 to 2.74) | 71 | 30.1 | 2.45 (1.90 to 3.13) | 1297 | 619 | 2.17 (2.05 to 2.30) |
Myxoedema 0 to 90 | 38 | 39.8 | 0.95 (0.66 to 1.32) | 126 | 95.9 | 1.48 (1.18 to 1.85) | 2617 | 2058 | 1.48 (1.41 to 1.56) |
91+ | 160 | 107 | 1.52 (1.29 to 1.79) | 305 | 245 | 1.32 (1.16 to 1.51) | 8487 | 7237 | 1.26 (1.22 to 1.29) |
Psoriasis 0 to 90 | 12 | 11.6 | 1.04 (0.53 to 1.83) | 15 | 6.5 | 2.41 (1.33 to 4.06) | 226 | 134 | 1.73 (1.51 to 1.98) |
91+ | 87 | 54.2 | 1.62 (1.29 to 2.00) | 38 | 26.5 | 1.45 (1.02 to 2.01) | 1092 | 679 | 1.64 (1.54 to 1.75) |
Rheumatoid arthritis: 0 to 90 | 52 | 61.7 | 0.83 (0.61 to 1.10) | 50 | 37.0 | 1.43 (1.03 to 1.95) | 1122 | 730 | 1.71 (1.60 to 1.83) |
91+ | 395 | 279.8 | 1.46 (1.31 to 1.62) | 231 | 156 | 1.60 (1.38 to 1.85) | 5703 | 3626 | 1.75 (1.70 to 1.81) |
SLE 0 to 90 | 5 | 1.4 | 3.64 (1.18 to 8.56) | 6 | 1.8 | 3.41 (1.24 to 7.75) | 111 | 27.4 | 4.15 (3.40 to 5.01) |
91+ | 21 | 6.5 | 3.25 (2.01 to 4.98) | 29 | 5.9 | 5.03 (3.35 to 7.27) | 525 | 148 | 3.61 (3.31 to 3.94) |
Absolute risk
Discussion
Methodological issues: datasets, population, and multiple comparisons
Conclusion
Appendix
Dataset (years) | ||||||
---|---|---|---|---|---|---|
Immune-mediated disease (ICD code3) | ORLS1 (1963 to 1998) | ORLS2 (1999 to 2008) | England (1999 to 2008) | |||
O
|
E
|
O
|
E
|
O
|
E
| |
Addison's disease (255.4) | 13 | 8.7 | 12 | 4.1 | 205 | 95.9 |
Ankylosing spondylitis (720) | 18 | 13.4 | 10 | 8.5 | 373 | 194.7 |
Autoimmune haemolytic anaemia (283) | 16 | 5.7 | 17 | 4.7 | 353 | 93.4 |
Chronic active hepatitis (571.4) | 15 | 6.7 | 6 | 1.5 | 93 | 45.7 |
Coeliac disease (579.0) | 27 | 20.0 | 24 | 17.8 | 474 | 392.0 |
Dermatomyositis, polymyositis (710.3,710.4) | 11 | 5.6 | 7 | 2.4 | 167 | 55.2 |
Diabetes mellitus under 30 (250) | 23 | 11.2 | 18 | 6.7 | 224 | 96.9 |
Goodpasture's syndrome (466.2) | 2 | 0.9 | 4 | 0.6 | 24 | 8.6 |
Hashimoto's thyroiditis (245) | 8 | 9.0 | 3 | 3.3 | 100 | 70.9 |
Idiopathic thrombocytopenia purpura (287.3) | 9 | 4.4 | 21 | 13.4 | 465 | 225.0 |
Multiple sclerosis (340) | 106 | 48.2 | 88 | 36.6 | 1509 | 728.8 |
Myasthenia gravis (358) | 13 | 6.4 | 13 | 5.6 | 282 | 125.9 |
Myxoedema (244) | 202 | 139.8 | 431 | 342.2 | 11104 | 9284.7 |
Pemphigus, pemphigoid (694.4,694.5) | 38 | 14.2 | 23 | 7.1 | 375 | 170.8 |
Pernicious anaemia (281) | 120 | 100.5 | 30 | 21.0 | 1012 | 754.2 |
Polyarteritis nodosa (446) | 18 | 6.3 | 3 | 0.7 | 73 | 20.7 |
Primary biliary cirrhosis (571.6) | 7 | 5.4 | 11 | 4.0 | 150 | 101.2 |
Psoriasis (696.0,696.1,696.8,696.9) | 99 | 61.7 | 53 | 32.8 | 1318 | 812.5 |
Rheumatoid arthritis (714) | 450 | 322.1 | 281 | 192.9 | 6825 | 4352.5 |
Scleroderma (710.1) | 9 | 4.2 | 9 | 5.9 | 244 | 124.8 |
Sjogren's syndrome (710.2) | 10 | 3.5 | 13 | 6.8 | 305 | 152.2 |
Systemic lupus erythematosus (710.0) | 26 | 7.2 | 35 | 7.8 | 636 | 174.8 |
Thyrotoxicosis (242) | 134 | 117.8 | 83 | 54.7 | 1429 | 1081.7 |