Background Rheumatoid arthritis (RA) is associated with an excess of mortality. This risk depends on disease activity, severity and associated comorbidities.

Objectives Our objective was to study the mortality profile of RA patients in France using multiple-cause-of-death analysis.

Methods Data were collected between 2000 and 2011 in the French Epidemiological Center for the Medical Causes of Death database, and death certificates issued upon the death of an adult for whom RA was an underlying cause of death (UCD) or a non-underlying cause of death (NUCD) were evaluated using multiple-cause-of-death analysis. Sex, age, sex ratio, standardized mortality rates, as well as frequency of the various causes of death were assessed. For the main causes of death, the observed number of deaths in relation to the expected number of deaths (O:E ratio) was calculated.

Results During the study period, 13,208 deaths related to RA were identified. RA was identified as the UCD in 4597 (35%) certificates. The number of certificates mentioning RA as the UCD decreased from 38 to 27% between 2000 and 2011. The mean±SD age at death was 79 ± 9 years (51% with ≥80 years). The female: male ratio was 3.2 and remained stable during the follow-up period. This ratio was significantly higher in the population where RA was the UCD (4.1 vs. 2.8 p<0.001). The mean standardized mortality rate was 0.25 per 1 million people (range 0.21–0.28), and remained stable throughout the period. When RA was the UCD (n=4,597), the main NUCDs were cardiovascular diseases (29%) and infectious diseases (22%). When RA was a NUCD (n=8,611), the most common UCDs were cardiovascular diseases (35% of certificates, including 877 patients with ischemic heart disease), neoplasms (15%), respiratory diseases (10%) and infectious diseases (7%). The overall O:E ratio was >1 for infectious (3.56), respiratory (1.40) and cardiovascular diseases (1.24), but was <1 for neoplasms.

Conclusions This is the first national study using a multiple-cause-of-death analysis to study the mortality profile of patients with RA. Our results show that cardiovascular diseases are the most common UCD and NUCD associated with RA in France. These data strengthen the need to develop specific strategies for cardiovascular prevention to improve survival of patients with RA.

Disclosure of Interest None declared