Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr;37(4):487-493.
doi: 10.1007/s00296-016-3638-5. Epub 2016 Dec 28.

Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study

J van den Hoek  1   2 , H C Boshuizen  3   4 , L D Roorda  5 , G J Tijhuis  6 , M T Nurmohamed  6 , G A M van den Bos  7 , J Dekker  5   8
Affiliations

Mortality in patients with rheumatoid arthritis: a 15-year prospective cohort study

J van den Hoek et al. Rheumatol Int. 2017 Apr.

Abstract

The aim of this study was to investigate (a) the mortality in a clinical cohort of patients with established rheumatoid arthritis in comparison with the general Dutch population over 15 years, (b) the trend in the mortality ratio during the study period, and (c) causes of death and compare these with the general population. In 1997, a sample of 1222 patients was randomly selected from the register of a large rheumatology outpatient clinic. Their mortality and primary causes of death between 1997 and 2012 were obtained from Statistics Netherlands. The standardized mortality ratio (SMR) for all-cause mortality and the number of life-years lost in the study period, adjusted for age, sex, and calendar year, were calculated. A linear poisson regression analysis was performed to evaluate change in all-cause SMR over time. Finally, the SMRs for cause-specific mortality were calculated. The mean age of the population at baseline was 60.4 (SD 15.4) years, and 72.6% of the patients were women. The estimated SMR (95% CI) for all-cause mortality was 1.54 (1.41, 1.67) with about one life-year lost over the study period. There was a trend to decreasing SMR (2% annually, p = .07). Mortality was higher compared with the general population for circulatory system diseases, respiratory system diseases, musculoskeletal system diseases, and digestive system diseases (p < .05). The observed mortality among patients with RA was 54% higher than in the general population after adjustment for age, sex and calendar year. More than one life-year was lost over 15 years, and the mortality tended to decrease over time. The mortality was higher for cardiovascular, respiratory, musculoskeletal and digestive diseases.

Keywords: Cause of death; Cohort study; Comorbidity; Longitudinal studies; Mortality; Rheumatoid arthritis; Survival.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

Authors van den Hoek, Boshuizen, Roorda, Tijhuis, Nurmohamed, van den Bos, and Dekker declare that they have no conflict of interest.

Ethical approval

Data were collected by means of the mortality records of the Statistics Netherlands. The Statistics Netherlands fulfils the Statistics Netherlands Act. The act includes that the data are published only in a way that no identifiable information about an individual person, household, company, or institution can be derived. The director general may, on request, provide or grant access to a set of data to a department, organization, or institution for the purposes of statistical or academic research where appropriate measures have been taken, to prevent identification of individual persons, households, companies, or institutions from those data. Permission has been provided by the director general to use the mortality data of this cohort, for this study [42].

Figures

Fig. 1
Fig. 1
Annual standardized mortality ratio and 95% confidence interval
See this image and copyright information in PMC

References

    1. Dadoun S, Zeboulon-Ktorza N, Combescure C, Elhai M, Rozenberg S, Gossec L, et al. Mortality in rheumatoid arthritis over the last fifty years: systematic review and meta-analysis. Jt Bone Spine. 2013;80:29–33. doi: 10.1016/j.jbspin.2012.02.005. - DOI - PubMed
    1. Goodson N, Marks J, Lunt M, Symmons D. Cardiovascular admissions and mortality in an inception cohort of patients with rheumatoid arthritis with onset in the 1980s and 1990s. Ann Rheum Dis. 2005;64:1595–1601. doi: 10.1136/ard.2004.034777. - DOI - PMC - PubMed
    1. Krishnan E, Lingala VB, Singh G. Declines in mortality from acute myocardial infarction in successive incidence and birth cohorts of patients with rheumatoid arthritis. Circulation. 2004;110:1774–1779. doi: 10.1161/01.CIR.0000142864.83780.81. - DOI - PubMed
    1. Mattey DL, Glossop JR, Nixon NB, Dawes PT. Circulating levels of tumor necrosis factor receptors are highly predictive of mortality in patients with rheumatoid arthritis. Arthritis Rheum. 2007;56:3940–3948. doi: 10.1002/art.23075. - DOI - PubMed
    1. Sihvonen S, Korpela M, Laippala P, Mustonen J, Pasternack A. Death rates and causes of death in patients with rheumatoid arthritis: a population-based study. Scand J Rheumatol. 2004;33:221–227. doi: 10.1080/03009740410005845. - DOI - PubMed

LinkOut - more resources