Trends in All-Cause and Cause-Specific Mortality Examined in Rheumatoid Arthritis

Trends in all-cause and cause-specific mortality risk were assessed among patients with rheumatoid arthritis.

Although mortality risk in rheumatoid arthritis (RA) is decreasing over time, gaps still remain for all-cause and cause-specific mortality, according to study findings published in Arthritis Care & Research (Hoboken).

Researchers conducted a matched cohort study to examine temporal trends in all-cause and cause-specific mortality among veterans with RA receiving care through the Veteran’s Health Administration (VHA) between January 2000 and December 2017.

A total of 29,779 veterans with RA were matched with 245,226 patients without RA.

During the 18-year period, 9565 patients with RA died compared with 62,896 of those without RA. The most common causes of death among patients with RA included cardiovascular disease, cancer, and respiratory diseases.

Patients with vs without RA had higher all-cause mortality rates (46.0 vs 34.1 deaths per 1000 person-years). Patients with RA had a 23% increased risk for all-cause mortality (adjusted hazard ratio [aHR], 1.23; 95% CI, 1.20-1.26).

These findings illustrate the need for continued efforts to provide holistic care to improve the longevity of patients with RA and further underscore the potential for RA lives saved with improved prevention and management of cardiopulmonary disease.

Cause-specific mortality rates also were higher among veterans with RA, with RA correlating to higher risk for deaths associated with cardiovascular disease (aHR, 1.19; 95% CI, 1.14-1.23), cancer (aHR, 1.19; 95% CI, 1.14-1.24), respiratory conditions (aHR, 1.46; 95% CI, 1.38-1.55), and infections (aHR, 1.59; 95% CI, 1.41-1.80).

In addition, RA correlated with increased risk for external causes of death (aHR, 1.11; 95% CI, 1.00-1.24), skin disorders (aHR, 2.73; 95% CI, 2.11-3.54), and nonmalignant disorders of the blood, such as aplastic anemia, coagulopathies, and immunodeficiencies (aHR, 2.55; 95% CI, 2.15-3.03).

The researchers observed temporal trends during the 18-year follow-up period, showing numerical improvements in RA-related mortality risk, particularly between 2006 and 2011 and 2012 and 2017 compared with 2000 and 2005. Patients with RA had a 1.5-fold increased risk for death between 2000 and 2005.

Despite improvements in mortality risk, approximately 25% of deaths among patients with RA during the most recent time periods occurred prematurely.

Study limitations included the predominance of men in the veteran population, which affected the generalizability of the results, potential risk for residual or unmeasured confounding factors due to the observational nature of the study, possible misclassification of causes of death, and the constraints of using possibly underpowered linear-trend assessments.

“These findings illustrate the need for continued efforts to provide holistic care to improve the longevity of patients with RA and further underscore the potential for RA lives saved with improved prevention and management of cardiopulmonary disease,” the study authors concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Johnson TM, Yang Y, Roul P, et al. A narrowing mortality gap: Temporal trends of cause-specific mortality in a national, matched cohort study in U.S. veterans with rheumatoid arthritis. Arthritis Care Res (Hoboken). Published online November 4, 2022. doi:10.1002/acr.25053