Abhishek, A, Nakafero, G, Kuo, C-F, Mallen, CD ORCID: 0000-0002-2677-1028, Zhang, W, Grainge, MJ and Doherty, M (2018) Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research Datalink. Rheumatology, 57 (6). 977 - 981. ISSN 1462-0332

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Abstract

Objectives: To examine temporal trends in all-cause and cause-specific mortality in RA. Methods: Data from the Clinical Practice Research Datalink were used. Incident RA cases and four age-, sex- and general practice-matched controls were identified from at-risk cohorts for each calendar year and followed-up for up to 5 years. Mortality rates and 95% CIs were computed. Cox proportional hazard ratios (HRs) were calculated to estimate associations and adjusted for covariates. The temporal trend in mortality was examined using the Joinpoint regression program. Data management and analysis were performed using Stata version 14. Results: A total of 21 622 cases with incident RA and 86 488 controls were included. The mortality rate of RA cases and controls was 26.90 (95% CI 25.87, 27.97) and 18.92 (18.48, 19.36)/1000 person-years, respectively. The mortality rate in RA cases did not change significantly between 1990 and 2004 but decreased by 7.7%/year between 2005 and 2009. However, the mortality rate in controls improved steadily by 2.2%/year between 1990 and 2009. RA was associated with a 32% excess risk of mortality in the entire cohort [adjusted HR 1.32 (95% CI 1.26, 1.38)], but this was only 15% in cases incident after 2006 [adjusted HR 1.15 (95% CI 1.03, 1.29)]. Similarly, the HR of death due to cardiovascular diseases decreased in cases incident in recent years. Conclusion: The mortality rate in RA cases incident after the year 2006 has declined significantly, with a trend towards a decline in death from cardiovascular diseases. This could be due to improved management of RA. However, even in cohorts from recent years, RA still associates with higher mortality rates.

Item Type: Article
Additional Information: © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords: Adult, Aged, Arthritis, Rheumatoid, Biomedical Research, Cardiovascular Diseases, Cause of Death, Comorbidity, Female, Forecasting, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Risk Factors, Survival Rate, United Kingdom
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC927 Rheumatism
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 05 Sep 2018 08:07
Last Modified: 05 Sep 2018 08:07
URI: http://eprints.keele.ac.uk/id/eprint/5286

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