{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T11:14:47Z","timestamp":1775474087979,"version":"3.50.1"},"reference-count":54,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,21]],"date-time":"2024-01-21T00:00:00Z","timestamp":1705795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: (1) Influence of comorbidities on life expectancy and treatment outcomes is one of the main concerns of modern rheumatology, due to their rising prevalence and increasing impact on mortality and disability. The main objective of our study was to analyze the time trends and shifts in the comorbidity profile and mortality over 10 years in the Polish population with ankylosing spondylitis (AS). (2) Data from 2011\u20132020 years were acquired from the General Hospital Morbidity Study in the National Institute of Public Health\u2014National Institute of Hygiene (NIH-PIB) as ICD-10 codes. Based on ICD10 codes, we calculated the percentage shares for comorbidities, with the relative risk ratios and odds ratios. We analyzed the hospitalization rates and mortality from the overlapping conditions. Also, we analyzed age and sex related differences in the clinical manifestations of AS patients. (3) Results: From 53,142 hospitalizations of patients with AS, we found that the male population presented higher rates of cardiovascular (2.7% vs. 1.3% p &lt; 0.001) and pulmonary conditions (1.2% vs. 0.8% p &lt; 0.025). Inflammatory bowel diseases were more common in the female population than in males (2.3% vs. 1.7%, p &lt; 0.001). In the years 2011\u20132020, we observed a decline in the number of hospitalized patients due to cardiovascular (p &lt; 0.001) and respiratory system conditions (p &lt; 0.001), yet the relative risk and odd ratios remained high. In the years 2011\u20132020, 4056 patients received biological treatment (7%). The number of initiated biological therapies correlated negatively with the number of reported hospitalizations due to ischemic heart diseases (IHD) (p &lt; 0.031, r = \u22120.8). Furthermore, in the logistic regression model, we found strong collinearity between cardiovascular and pulmonary comorbidities (VIF = 14; tolerance = 0.1); also, the number of reported IHD\u2019s correlated positively with the number of pulmonary infections (p &lt; 0.031, r = 0.7) (4). Conclusions: Cardiopulmonary comorbidities are a main factor associated with increased mortality in patients with AS, especially in hospitalized patients. The mortality rates among patients with AS admitted to hospital due to other conditions other than movement disorders exceed the populational risk. The number of biologically treated patients correlated negatively with hospital admissions due to IHD.<\/jats:p>","DOI":"10.3390\/jcm13020602","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T11:36:41Z","timestamp":1705923401000},"page":"602","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Time Trend Analysis of Comorbidities in Ankylosing Spondylitis: A Population-Based Study from 53,142 Hospitalizations in Poland"],"prefix":"10.3390","volume":"13","author":[{"given":"Katarzyna","family":"Helon","sequence":"first","affiliation":[{"name":"Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ma\u0142gorzata","family":"Wis\u0142owska","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8931-8565","authenticated-orcid":false,"given":"Krzysztof","family":"Kanecki","sequence":"additional","affiliation":[{"name":"National Institute of Public Health\u2014National Institute of Hygiene, 00791 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawe\u0142","family":"Gory\u0144ski","sequence":"additional","affiliation":[{"name":"National Institute of Public Health\u2014National Institute of Hygiene, 00791 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aneta","family":"Nitsch-Osuch","sequence":"additional","affiliation":[{"name":"National Institute of Public Health\u2014National Institute of Hygiene, 00791 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0814-4063","authenticated-orcid":false,"given":"Krzysztof","family":"Bonek","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3389\/fmed.2018.00062","article-title":"Comorbidities in Spondyloarthritis","volume":"5","author":"Nikiphorou","year":"2018","journal-title":"Front. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/s13075-019-1995-7","article-title":"Depression in ankylosing spondylitis and the role of disease-related and contextual factors: A cross-sectional study","volume":"21","author":"Webers","year":"2019","journal-title":"Arthritis Res. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3899\/jrheum.210909","article-title":"Mortality Rates in Patients with Ankylosing Spondylitis with and without Extraarticular Manifestations and Comorbidities: A Retrospective Cohort Study","volume":"49","author":"Kelty","year":"2022","journal-title":"J. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s12939-023-01988-2","article-title":"Temporal trends in inequalities of the burden of cardiovascular disease across 186 countries and territories","volume":"22","author":"Deng","year":"2023","journal-title":"Int. J. Equity Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.3389\/fmed.2018.00197","article-title":"Editorial: Comorbidity Burden in Rheumatic Diseases","volume":"5","author":"Nikiphorou","year":"2018","journal-title":"Front. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3961\/jpmph.21.594","article-title":"Measuring Trends in the Socioeconomic Burden of Disease in Korea, 2007\u20132015","volume":"55","author":"Kim","year":"2022","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"782150","DOI":"10.3389\/fmed.2021.782150","article-title":"The Risk of Cardiovascular Diseases in Axial Spondyloarthritis. Current Insights","volume":"8","author":"Toussirot","year":"2021","journal-title":"Front. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.3748\/wjg.v25.i18.2162","article-title":"Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment","volume":"25","author":"Fragoulis","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1001\/jamapediatrics.2015.1982","article-title":"Inflammatory bowel disease in children and adolescents","volume":"169","author":"Rosen","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1038\/nrrheum.2017.56","article-title":"Pathogenesis of ankylosing spondylitis\u2014Recent advances and future directions","volume":"13","author":"Ranganathan","year":"2017","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lin, A., Tan, Y., Chen, J., Liu, X., and Wu, J. (2023). Development of ankylosing spondylitis in patients with ulcerative colitis: A systematic meta-analysis. PLoS ONE., 18.","DOI":"10.1371\/journal.pone.0289021"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.31138\/mjr.34.1.24","article-title":"Ocular Manifestations of Spondyloarthritis","volume":"34","author":"Pandey","year":"2023","journal-title":"Mediterr. J. Rheumatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"811664","DOI":"10.3389\/fimmu.2021.811664","article-title":"Uveitis as a Risk Factor for Developing Acute Myocardial Infarction in Ankylosing Spondylitis: A National Population-Based Longitudinal Cohort Study","volume":"12","author":"Lai","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.3892\/ol.2017.6368","article-title":"Ankylosing spondylitis and the risk of cancer","volume":"14","author":"Chang","year":"2017","journal-title":"Oncol. Lett."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1136\/ard.2002.004721","article-title":"Cancer incidence among patients with ankylosing spondylitis in Sweden 1965\u201395: A population based cohort study","volume":"62","author":"Feltelius","year":"2003","journal-title":"Ann. Rheum. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bittar, M., Merjanah, S., Alkilany, R., and Magrey, M. (2022). Malignancy in ankylosing spondylitis: A cross-sectional analysis of a large population database. BMC Rheumatol., 6.","DOI":"10.1186\/s41927-022-00275-x"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kagan, P., Horesh, N., Amital, H., Tsur, A.M., Watad, A., Cohen, A.D., and Ben-Shabat, N. (2023). The Risk and Predictors of Malignancies in Ankylosing Spondylitis Patients in Israel\u2014A Retrospective Electronic Data-Based Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12155153"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1159\/000521952","article-title":"Comorbidity: From a Confounder in Longitudinal Clinical Research to the Main Issue in Population Management","volume":"91","author":"Charlson","year":"2022","journal-title":"Psychother. Psychosom."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Shrikrishna, D., Taylor, C.J., Stonham, C., and Gale, C.P. (2023). Exacerbating the burden of cardiovascular disease: How can we address cardiopulmonary risk in individuals with chronic obstructive pulmonary disease?. Eur. Heart J., ehad669.","DOI":"10.1093\/eurheartj\/ehad669"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kao, C.-M., Wang, J.-S., Ho, W.-L., Ko, T.-M., Chen, H.-M., Lin, C.-H., Huang, W.-N., Chen, Y.-H., and Chen, H.-H. (2022). Factors Associated with the Risk of Major Adverse Cardiovascular Events in Patients with Ankylosing Spondylitis: A Nationwide, Population-Based Case\u2014Control Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19074098"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s11606-019-05486-6","article-title":"Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death","volume":"35","author":"Joodi","year":"2020","journal-title":"J. Gen. Intern. Med."},{"key":"ref_22","first-page":"132","article-title":"The prevalence of comorbidity and predictors in ankylosing spondylitis","volume":"65","author":"Paker","year":"2018","journal-title":"Turk. J. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1177\/2192568220980702","article-title":"Factors Associated with Major Complications and Mortality During Hospitalization in Patients with Ankylosing Spondylitis Undergoing Surgical Management for a Spine Fracture","volume":"12","author":"Ull","year":"2022","journal-title":"Glob. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/1756-185X.14036","article-title":"Cancer diagnosis and mortality in patients with ankylosing spondylitis: A Western Australian retrospective cohort study","volume":"24","author":"Kelty","year":"2021","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ye, W., Zhuang, J., Yu, Y., Li, H., Leng, X., Qian, J., Qin, Y., Chen, L., and Li, X.M. (2019). Gender and chronic kidney disease in ankylosing spondylitis: A single-center retrospectively study. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1658-6"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1136\/annrheumdis-2016-209315","article-title":"Is ankylosing spondylitis a risk factor for cardiovascular disease, and how do these risks compare with those in rheumatoid arthritis?","volume":"76","author":"Eriksson","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"645","DOI":"10.3899\/jrheum.141018","article-title":"Disease activity in ankylosing spondylitis and associations to markers of vascular pathology and traditional cardiovascular disease risk factors: A cross-sectional study","volume":"42","author":"Berg","year":"2015","journal-title":"J. Rheumatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"102891","DOI":"10.1016\/j.autrev.2021.102891","article-title":"Arterial stiffness, the hidden face of cardiovascular risk in autoimmune and chronic inflammatory rheumatic diseases","volume":"20","author":"Berger","year":"2021","journal-title":"Autoimmun. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Asenjo-Lobos, C., Gonz\u00e1lez, L., Bulnes, J.F., Roque, M., Mu\u00f1oz Venturelli, P., and Rodr\u00edguez, G.M. (2023). Cardiovascular events risk in patients with systemic autoimmune diseases: A prognostic systematic review and meta-analysis. Clin. Res. Cardiol., ahead of print.","DOI":"10.1007\/s00392-023-02291-4"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s13075-017-1315-z","article-title":"Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study","volume":"19","author":"Bengtsson","year":"2017","journal-title":"Arthritis Res. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.3389\/fimmu.2018.01682","article-title":"The IL-17 family of cytokines in psoriasis: IL-17A and beyond","volume":"9","author":"Brembilla","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bonek, K., Kuca-Warnawin, E., Kornatka, A., Zieli\u0144ska, A., Wis\u0142owska, M., Kontny, E., and G\u0142uszko, P. (2022). Associations of IL-18 with Altered Cardiovascular Risk Profile in Psoriatic Arthritis and Ankylosing Spondylitis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030766"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"890543","DOI":"10.3389\/fimmu.2022.890543","article-title":"Increased Risk of Acute Coronary Syndrome in Ankylosing Spondylitis Patients with Uveitis: A Population-Based Cohort Study","volume":"13","author":"Feng","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1007\/s40744-020-00248-x","article-title":"Effects of Therapies on Cardiovascular Events in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis","volume":"7","author":"Karmacharya","year":"2020","journal-title":"Rheumatol. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"264","DOI":"10.20452\/pamw.15324","article-title":"In-hospital mortality in Poland: What can we learn from administrative data?","volume":"130","author":"Koperny","year":"2020","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_37","first-page":"268","article-title":"Predictors of in-hospital mortality in nonsurgical departments: A multivariable regression analysis of 2855029 hospitalizations","volume":"130","author":"Walicka","year":"2020","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.ijcard.2016.02.015","article-title":"The gender gap in risk factor control: Effects of age and education on the control of cardiovascular risk factors in male and female coronary patients. The EUROASPIRE IV study by the European Society of Cardiology","volume":"209","author":"Dallongeville","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1177\/2047487315569401","article-title":"EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries","volume":"23","author":"Kotseva","year":"2016","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1161\/01.cir.0000442015.53336.12","article-title":"Executive summary: Heart disease and stroke statistics\u20142014 update: Report from the American Heart Association","volume":"129","author":"Go","year":"2014","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e3596","DOI":"10.1097\/MD.0000000000003596","article-title":"Midlife ankylosing spondylitis increases the risk of cardiovascular diseases in males 5 years later: A national population-based study","volume":"95","author":"Hung","year":"2016","journal-title":"Medicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1007\/s10067-016-3362-2","article-title":"Prevalence of cardiovascular-related comorbidity in ankylosing spondylitis, psoriatic arthritis and psoriasis in primary care: A matched retrospective cohort study","volume":"35","author":"Ahmed","year":"2016","journal-title":"Clin. Rheumatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"951","DOI":"10.5114\/aoms.2017.72423","article-title":"Prevalence, awareness, treatment and control of hypertension in the adult Polish population\u2014Multi-center National Population Health Examination Surveys\u2014WOBASZ studies","volume":"14","author":"Niklas","year":"2018","journal-title":"Arch. Med. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.2147\/CIA.S265993","article-title":"The Severity of Changes in Cardiovascular Risk Factors in Adults over a Five-Year Interval","volume":"15","author":"Cybulska","year":"2020","journal-title":"Clin. Interv. Aging"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Moryson, W., Kalinowski, P., Kotecki, P., and Stawi\u0144ska-Witoszy\u0144ska, B. (2023). Changes in the Level of Premature Mortality in the Polish Population Due to Selected Groups of Cardiovascular Diseases before and during the Pandemic of COVID-19. J. Clin. Med., 12.","DOI":"10.3390\/jcm12082913"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"7214","DOI":"10.1021\/acs.est.1c04176","article-title":"Cardiopulmonary Mortality and Fine Particulate Air Pollution by Species and Source in a National U.S. Cohort","volume":"56","author":"Pond","year":"2022","journal-title":"Environ. Sci. Technol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"728471","DOI":"10.1155\/2011\/728471","article-title":"Cardiopulmonary manifestations of ankylosing spondylitis","volume":"2011","author":"Momeni","year":"2011","journal-title":"Int. J. Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"S169","DOI":"10.1513\/AnnalsATS.201503-126AW","article-title":"Immune Dysfunction in Patients with Chronic Obstructive Pulmonary Disease","volume":"12","author":"Bhat","year":"2015","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1161\/HYPERTENSIONAHA.119.14608","article-title":"Effects of Chronic Nicotine Inhalation on Systemic and Pulmonary Blood Pressure and Right Ventricular Remodeling in Mice","volume":"75","author":"Oakes","year":"2020","journal-title":"Hypertension"},{"key":"ref_50","unstructured":"(2023, June 11). Available online: https:\/\/www.abdn.ac.uk\/iahs\/research\/epidemiology\/bsrbras-1438.php."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Lungaro, L., Costanzini, A., Manza, F., Barbalinardo, M., Gentili, D., Guarino, M., Caputo, F., Zoli, G., De Giorgio, R., and Caio, G. (2023). Impact of Female Gender in Inflammatory Bowel Diseases: A Narrative Review. J. Pers. Med., 13.","DOI":"10.3390\/jpm13020165"},{"key":"ref_52","unstructured":"(2023, June 11). Available online: https:\/\/www.framinghamheartstudy.org\/."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3389\/fphar.2019.00047","article-title":"Sex Differences in Response to TNF-Inhibiting Drugs in Patients with Spondyloarthropathies or Inflammatory Bowel Diseases","volume":"10","author":"Zullo","year":"2019","journal-title":"Front. Pharmacol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11926-018-0744-2","article-title":"Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky","volume":"20","author":"Rusman","year":"2018","journal-title":"Curr. Rheumatol. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/602\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:46:34Z","timestamp":1760103994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/602"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,21]]},"references-count":54,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13020602"],"URL":"https:\/\/doi.org\/10.3390\/jcm13020602","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,21]]}}}