OMAHA — Although lessening over time, patients with rheumatoid arthritis (RA) in the VHA have higher risk of all-cause and cause-specific mortality, according to a new study.
To determine that, researchers from the VA Nebraska-Western Iowa Health Care System and the University of Nebraska Medical Center, both in Omaha, and colleagues conducted a matched cohort study of veterans been treated by the VHA from Jan. 1, 2000, to Dec. 31, 2017. VAMCs in Salt Lake City and Philadelphia also participated in the research. The results were published in Arthritis Care & Research.1
The study team matched non-RA patients to incident RA patients up to 1:10 on age, sex and VHA enrollment year; participants were followed until death or the end of the study.
During the study period, 9,565 deaths occurred among 29,779 incident RA patients (matched to 245,226 non-RA patients). Results indicated that RA patients were at increased risk of mortality from:
- all-causes (aHR 1.23, 95% CI 1.20-1.26),
- cardiovascular disease (aHR 1.19, 1.14-1.23),
- cancer (aHR 1.19, 1.14-1.24),
- respiratory disease (aHR 1.46, 1.38-1.55), and
- infection-related mortality (aHR 1.59, 1.41-1.80).
Most strongly associated with RA was death from interstitial lung disease (ILD) (aHR 3.39, 2.88-3.99). In addition, nearly 70% of excess deaths in RA were attributable to cardiopulmonary disease.
Researchers reported that all-cause mortality risk related to RA was lower among veterans diagnosed during 2012-2017 (aHR 1.10, 1.05-1.15) compared to 2000-2005 (aHR 1.31, 1.26-1.36) but remained higher than non-RA controls (p<0.001). Cause-specific mortality trends were similar, they added.
“Excess RA-related mortality was driven by cardiovascular, cancer, respiratory, and infectious causes, particularly cardiopulmonary diseases,” the authors concluded. “Though our findings support that RA-related mortality risk is decreasing over time, a mortality gap remains for all-cause and cause-specific mortality in RA.”
- Johnson TM, Yang Y, Roul P, Sauer BC, 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). 2022 Nov 4. doi: 10.1002/acr.25053. Epub ahead of print. PMID: 36331101.
