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. 2025 Mar 14;15(1):8803.
doi: 10.1038/s41598-024-84856-5.

Sex differences in the risk of incident systemic sclerosis: a nationwide population-based study with subgroup analyses

Oh Chan Kwon  1 , Kyungdo Han  2 , Min-Chan Park  3   4
Affiliations

Sex differences in the risk of incident systemic sclerosis: a nationwide population-based study with subgroup analyses

Oh Chan Kwon et al. Sci Rep. .

Abstract

Although higher prevalence of systemic sclerosis (SSc) in women than in men is well-known, it is unclear to what degree women are at higher risk of developing incident SSc. This study aims to assess the risk of incident SSc comparing women vs. men, and to identify subsets of individuals in whom the risk difference according to sex is more prominent. An analysis of a Korean nationwide cohort of 9,894,996 individuals was conducted. All individuals were followed up from 2009 to 2019. Cox proportional hazard models were used to assess the risk of incident SSc comparing women vs. men. Subgroup analysis was conducted by stratifying individuals according to multiple covariates. The absolute risk of SSc in men (i.e., background risk) was 0.004% (95% CI 0.003-0.004), and the absolute risk of SSc in women was 0.025% (95% CI 0.023-0.027). The absolute risk difference between women and men was 0.021% (95% CI 0.019-0.024). Women had a significantly higher risk of incident SSc than men (adjusted hazard ratio [aHR], 5.275; 95% confidence interval, 4.346-6.403). The effect size was more pronounced in middle-aged individuals (aHR 5.020 [< 40 years] vs. 5.868 [40-64 years] vs. 2.734 [≥ 65 years]; p-interaction < 0.001); those without abdominal obesity (aHR 5.863 vs. 3.658; p-interaction = 0.005); those who did not exercise regularly (aHR 5.701 vs. 3.932; p-interaction = 0.030); and those without hypertension (aHR 5.996 vs. 4.053; p-interaction = 0.010) or dyslipidemia (aHR 5.857 vs. 3.330; p-interaction = 0.001). Women had a 5-fold higher risk of incident SSc than men. The higher risk was more prominent in middle-aged individuals, those without abdominal obesity, those who do not exercise regularly, and do not have hypertension or dyslipidemia.

Keywords: Cohort; Epidemiology; Risk; Sex; Systemic sclerosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board (IRB) of Gangnam Severance Hospital (No: 3-2022-0338). Owing to the retrospective nature of this study, the requirement for informed consent was waived by the IRB of Gangnam Severance Hospital. This study conformed the ethical guidelines laid out by the 1964 Helsinki declaration. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study population. NHIS, National Health Insurance Service; SSc, systemic sclerosis.
See this image and copyright information in PMC

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