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How many life years are lost in patients with rheumatoid arthritis? Secular cause‐specific and all‐cause mortality in rheumatoid arthritis, and their predictors in a long‐term A ustralian cohort study
Author(s) -
Lassere M. N.,
Rappo J.,
Portek I. J.,
Sturgess A.,
Edmonds J. P.
Publication year - 2013
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2012.02727.x
Subject(s) - medicine , cohort , rheumatoid arthritis , cause of death , standardized mortality ratio , population , cohort study , pediatrics , surgery , disease , environmental health
Background There is an excess of mortality in patients with rheumatoid arthritis ( RA ) but no long‐term A ustralian cohort data. Aims To determine median life years lost, all‐cause standardised mortality ratio ( SMR ) and cause‐specific SMR , their predictors and secular change in A ustralian patients with RA . Methods Study population was all patients seen by a rheumatologist between 1990 and 1994. Record linkage with A ustralian N ational D eath I ndex was performed to determine fact and cause of death up to 2004. All‐cause and cause‐specific SMR , and median life years lost were determined. Results There were 35 (31%) deaths in the early 1990s cohort ( n = 113), SMR 1.31 (95% 0.93, 1.80). There were 216 (44%) deaths in the pre‐1990s established cohort ( n = 495), SMR 1.73 (1.49, 1.95). Median life years lost in the early cohort was 6 years for males and 7 years for females compared with 8 and 10 years, respectively, in the established cohort. Patients with low disease activity score at baseline ( DAS < 3.2), SMR was 0.8 (0.3, 2.2) and 1.5 (1.1, 2.2) for the early and established cohorts, and if DAS ≥3.2, SMR was 1.4 (1.02, 1.98) and 1.8 (1.5, 2.1) respectively. Primary cause of death was cardiovascular disease ( SMR 1.43 (1.17, 1.74). Patients at most risk were those age 45–54 years. RA was listed as a comorbid condition on the death certificate in only 16% of patients. Conclusions Within a period of 14 years, median life expectancy of patients with RA with disease onset in the early 1990s is reduced by 6–7 years. However, our results also suggest a secular reduction in excess mortality.