A Narrowing Mortality Gap: Temporal Trends of Cause‐Specific Mortality in a National Matched Cohort Study in US Veterans With Rheumatoid Arthritis
Authors' conclusion
Excess RA-related mortality was driven by cardiovascular, cancer, respiratory, and infectious causes, particularly cardiopulmonary diseases. Although our findings support that RA-related mortality risk is decreasing over time, a mortality gap remains for all-cause and cause-specific mortality in RA.
Study context
- Population
- Veterans Health Administration, January 1, 2000 to December 31, 2017: incident rheumatoid arthritis (RA) patients and matched non-RA patients9,565 deaths
- Participants
- 29,779 vs 245,226
- Exposure
- Incident RA vs matched non-RA patients
- RAn = 29,779
- Non-RAn = 245,226reference
- Outcome
- All-cause and cause-specific mortality (cause of death from the National Death Index) and their temporal trends
Methodological detailsmatched (up to 1:10) on age, sex and Veterans Health Administration (VHA) enrollment year, multivariable Cox regression stratified by RA diagnosis years
- Matched (up to 1:10) on age, sex and VHA enrollment year
- Multivariable Cox regression stratified by RA diagnosis years
Main finding
As reported in the abstract
All-cause and cause-specific mortality
RA vs Non-RAAdjusted hazard ratio (95% CI)
All-cause mortality
1.23(1.20–1.26)
Cardiovascular mortality
1.19(1.14–1.23)
Cancer mortality
1.19(1.14–1.24)
Respiratory mortality
1.46(1.38–1.55)
Infection-related mortality
1.59(1.41–1.80)
ILD death (cause most strongly associated with RA)
3.39(2.88–3.99)
- Excess deaths in RA attributable to cardiopulmonary disease
- Nearly 70%
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Temporal trend in RA-related all-cause mortality by diagnosis periodRA diagnosed 2012-2017vs Non-RALower than 2000-2005 but still higher than non-RA controls | 1.10 (1.05–1.15) | P < 0.001 | |
| Temporal trend in RA-related all-cause mortality by diagnosis periodRA diagnosed 2000-2005vs Non-RA | 1.31 (1.26–1.36) | ||
| 0.512Adjusted hazard ratio (log scale) |
Temporal trend in RA-related all-cause mortality by diagnosis period
- Cause-specific mortality trends were similar
Original publication
A Narrowing Mortality Gap: Temporal Trends of Cause‐Specific Mortality in a National Matched Cohort Study in US Veterans With Rheumatoid Arthritis. Arthritis Care Res (Hoboken). Published 25 January 2023. doi:10.
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