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Premature Mortality in Patients with Addison’s Disease: A Population-Based Study

Department of Endocrinology (R.B., M.L.-Z., G.J.), Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; and Department of Mathematical Sciences (A.O.), Chalmers University of Technology, SE-412 96 Gothenburg, Sweden

Address all correspondence and requests for reprints to: Ragnhildur Bergthorsdottir, M.D., Department of Endocrinology, gr str 8, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. E-mail: Ragnhildur.Bergthorsdottir{at}medic.gu.se.

Background: The survival rate of patients with primary adrenal insufficiency (Addison’s disease) undergoing currently accepted replacement therapy is not known, although well-informed patients are considered to have a normal survival rate. In this study, we evaluated the mortality of patients with Addison’s disease in Sweden.

Methods: A population-based, retrospective, observational study was performed, using the National Swedish Hospital and Cause of Death Registers, covering the period from 1987–2001. After a diagnosis of Addison’s disease, each patient was followed until the end of follow-up or death. Mortality was compared with that of the Swedish background population.

Findings: We identified 1675 patients (995 women and 680 men) diagnosed with primary adrenal insufficiency. The average follow-up from initial diagnosis was 6.5 yr. Five hundred seven patients died during the study period compared with an expected 199. The risk ratio for all-cause mortality was 2.19 (confidence interval 1.91–2.51) for men and 2.86 (confidence interval 2.54–3.20) for women. The excess mortality in both men and women was attributed to cardiovascular, malignant, and infectious diseases. Concomitant diabetes mellitus was observed in 12% of the patients, but only contributed to the increased mortality to a minor extent.

Interpretation: Compared with the background population, we observed that the risk ratio for death was more than 2-fold higher in patients with Addison’s disease. Cardiovascular, malignant, and infectious diseases were responsible for the higher mortality rate.

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