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Association of Giant Cell Arteritis With Race

Educational Objective
To examine the incidence of biopsy-proven giant cell arteritis (GCA) in a tertiary care center–based population with a sizeable proportion of black patients.
1 Credit CME
Key Points

Question  How does the incidence of giant cell arteritis in black patients compare with that in white patients?

Findings  In this cohort study from a US tertiary care center that included 586 patients who underwent temporal artery biopsy, the age- and sex-adjusted annual incidence rates of biopsy-proven giant cell arteritis in patients 50 years and older were 3.1 and 3.6 per 100 000 for black and white patients, respectively. An overall incidence rate ratio of 1.2 between races was not significant.

Meaning  These results suggest that giant cell arteritis occurs at a similar rate in white and black patients.

Abstract

Importance  Giant cell arteritis (GCA) is the most common vasculitis in adults and is associated with significant morbidity and mortality. Its incidence has been carefully studied in white populations, yet its relevance among other racial and ethnic groups is less well known.

Objective  To examine the incidence of biopsy-proven GCA (BP-GCA) in a tertiary care center–based population with a sizeable proportion of black patients.

Design, Setting, and Participants  This retrospective cohort study identified all patients who underwent temporal artery biopsy (TAB) from July 1, 2007, through September 30, 2017, using the electronic medical record system at the Johns Hopkins Wilmer Eye Institute. Associations between self-reported race, sex, and age were explored and compared with all other patients attending the hospital over the same period. Data were analyzed from November 1, 2017, through July 31, 2018.

Main Outcomes and Measures  Estimated incidence rates of BP-GCA in black and white patients.

Results  Among 586 patients who underwent TAB (mean [SD] age, 70.5 [11.1] years; age range, 32-103 years; 423 [72.2%] women), 167 (28.5%) were black, 382 (65.2%) were white, and 37 (6.3%) were other or unknown. Of 573 individuals 50 years and older, 92 (16.1%) had BP-GCA; 14 were black (8.4% of all black patients undergoing testing) and 75 were white (19.6% of all white patients undergoing testing). Crude annual incidence rates for BP-GCA were 2.9 (95% CI, 1.3-5.5) per 100 000 for black and 4.2 (95% CI, 3.0-5.6) per 100 000 for white patients within the study population. Population-adjusted age- and sex-standardized incidence rates were 3.1 (95% CI, 1.0-5.2) and 3.6 (95% CI, 2.5-4.7) per 100 000 for black and white patients, respectively (difference, 0.5; 95% CI, −1.7 to 2.7; P = .70). The incidence rate ratio was 1.9 in women compared with men (95% CI, 1.1-3.4; P = .03) but was not significant in white compared with black patients (1.2; 95% CI, 0.6-2.4; P = .66).

Conclusions and Relevance  In our cohort, BP-GCA occurred more commonly in women, but rates were similar between races. These findings do not appear to support the conclusion that GCA occurs more frequently in white compared with black patients.

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Article Information

Accepted for Publication: June 5, 2019.

Corresponding Author: Anna M. Gruener, BMBS, MSc, FRCOphth, Department of Ophthalmology, Nottingham University Hospitals National Health Service Trust, Derby Road, Nottingham NG7 2UH, United Kingdom (anna.gruener@nottingham.ac.uk).

Published Online: August 8, 2019. doi:10.1001/jamaophthalmol.2019.2919

Author Contributions: Drs Gruener and McCulley had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Gruener, Carey, Chang, McCulley.

Acquisition, analysis, or interpretation of data: Gruener, Poostchi, Carey, Eberhart, Henderson, Chang.

Drafting of the manuscript: Gruener, Poostchi, Carey, Chang, McCulley.

Critical revision of the manuscript for important intellectual content: Gruener, Poostchi, Eberhart, Henderson, Chang.

Statistical analysis: Poostchi, Carey, Chang.

Administrative, technical, or material support: Gruener, Carey, Eberhart, Chang.

Supervision: McCulley.

Conflict of Interest Disclosures: None reported.

Disclaimer: The content is solely the responsibility of the authors.

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