Rheumatoid arthritis and excess mortality: down but not out: a primary care cohort study using data from Clinical Practice Research Datalink

Abhishek, Abhishek and Nakafero, Georgina and Kuo, Chang-Fu and Mallen, Christian and Zhang, Weiya and Grainge, Matthew J. and Doherty, Michael (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). pp. 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 (CPRD) 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 five years. Mortality rates and 95% confidence intervals (95% CIs) were computed. Cox-proportional hazard ratios (HRs) were calculated to estimate associations and adjusted for covariates. Temporal trend in mortality was examined using the Joinpoints Regression Program. Data management and analysis were performed using Stata v.14.

Results: 21,622 cases with incident RA and 86,488 controls were included. The mortality rate (95%CI) of RA cases and controls was 26.90 (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 reduced 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 associated with 32% excess risk of mortality in the entire cohort (aHR (95%CI) 1.32(1.26-1.38), but this was only 15% in cases incident after 2006 (aHR (95%CI) 1.15(1.03-1.29)). Similarly, the HR of death due to cardiovascular diseases reduced 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 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: This is a pre-copyedited, author-produced version of an article accepted for publication in Rheumatology following peer review. The version of record Abhishek Abhishek, Georgina Nakafero, Chang-Fu Kuo, Christian Mallen, Weiya Zhang, Matthew J. Grainge, Michael Doherty; Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research Datalink, Rheumatology Volume 57, Issue 6, 1 June 2018, Pages 977–981, https://doi.org/10.1093/rheumatology/key013is available online at: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/key013/4904191
Keywords: Rheumatoid arthritis; Mortality; Temporal trends
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rheumatology, Orthopaedics and Dermatology
Identification Number: https://doi.org/10.1093/rheumatology/key013
Depositing User: Eprints, Support
Date Deposited: 19 Feb 2018 13:26
Last Modified: 11 Jun 2018 14:07
URI: http://eprints.nottingham.ac.uk/id/eprint/49858

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