Dupuytren Disease Predicts Increased Cancer and Cardiovascular Mortality

Abstract

Objective/Hypothesis: Dupuytren disease is an inherited fibroproliferative disease of the palmer fascia and frequently leads to disability and reduced quality of life. Previous small studies from Scandinavia have suggested that Dupuytren disease might be associated with increased mortality. We therefore hypothesized that Dupuytren disease would be associated with an increase in all-cause mortality within the UK and that this excess mortality might be accounted for by an increase in cancer or cardiovascular deaths. Materials and Methods: We harnessed the UK Clinical Research Practice Database (CPRD), a large primary care database containing the anonymized health records of approximately 8% of the UK population between January 1995 and December 2013. Cases were defined according to a code list defined by 2 independent clinically qualified researchers, with consensus reached by a third. Controls were matched by age, sex, and geographical location. Linked mortality data were provided by the Office for National Statistics. All-cause mortality, all cancer-related deaths, deaths from colorectal cancer, and deaths from cardiovascular disease were analyzed separately. Cox regression was used to calculate hazard ratios (HR). Kaplan-Meier survival estimates were also calculated. Results: We identified 42 192 incident cases of Dupuytren disease within the data set, and matched 210 960 controls. We found that the incidence of Dupuytren disease in the UK has increased during the study period for both men and women: men from 0.0169% to 0.0568% per year; women from 0.0068% to 0.0281% per year. All-cause mortality for patients with Dupuytren disease compared with patients without Dupuytren disease is increased in the second decade after diagnosis (HR, 1.70; 95% confidence interval [CI], 1.48-1.97; P = .0000). All cancer mortality (HR, 1.56; 95% CI, 1.34-1.81; P = .0000), colorectal cancer mortality (HR, 1.53; 95% CI, 1.18-2.00; P = .0025), and cardiovascular disease mortality (HR, 1.362; 95% CI, 1.23-1.51; P = .0000) are all likewise increased in the second decade after diagnosis. Conclusions: We find that the incidence of Dupuytren disease in the UK increased over the period 1995-2013. Patients with Dupuytren disease have significantly higher mortality rates 20 years after diagnosis than the population without Dupuytren disease. Specifically, Dupuytren disease patients are more likely to die from all cancers combined, colorectal cancer, and cardiovascular disease. Further work will allow the identification of causal pathways within this data set. The delay from diagnosis of Dupuytren disease to increased risk of death is over 10 years, allowing time for interventions that might reduce mortality in this patient group.