Background Rheumatoid arthritis (RA) is associated with an increased risk of mortality; however, recent mortality trends in RA are largely unknown, particularly in the general population.
Objectives To address this knowledge gap, we evaluated mortality trends among RA patients between Jan 1, 1999 and Dec 31, 2012 in a general population context.
Methods Using The Health Improvement Network, an electronic medical record database representative of the UK general population, we identified individuals with incident cases of RA and up to 5 non-RA controls matched on sex, age, year of birth, and year of RA diagnosis, between 1999 and 2012 (i.e., ≥1 year before the end of our dataset to allow for follow-up). The RA cohort was then divided in two cohorts based on the year of RA diagnosis (i.e., 1999-2005 and 2006-2012) to evaluate changes in mortality. We calculated hazard ratios for death using a Cox-proportional hazards model and the rate differences using an additive hazard model, while additionally adjusting for potential confounders (i.e., number of GP visits, body mass index, smoking, alcohol and Charlson Comorbidity Index).
Results The early cohort (1999-2005) RA patients had considerably higher mortality rates than the late cohort (2006-2012) (i.e., 23.8 vs. 15.7 cases per 1000 person-years), as compared with only a moderate improvement in the comparison cohorts between the two periods (14.1 to 11.1 cases per 1000 person-years). The corresponding absolute mortality rate differences were 9.7 (95% CI, 7.2-12.2) cases and 4.7 (95% CI, 2.9-6.4) cases per 1000 person-years (p for interaction <0.01) and the resulting HRs for mortality were 1.51 (95% CI, 1.33-1.72) and 1.21 (95% CI, 1.05-1.39), respectively (p for interaction=0.027).
Conclusions This general population-based study shows that survival of RA patients has improved over the past decade, suggesting that new treatments and improved management of complications and associated comorbidities may be providing substantial benefits.
Annals of the Rheumatic Diseases 2014 Jan;73(1):149-153.
Disclosure of Interest None declared