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

Abhishek, Abhishek; Nakafero, Georgina; Kuo, Chang-Fu; Mallen, Christian; Zhang, Weiya; Grainge, Matthew J.; Doherty, Michael

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.

Citation

Abhishek, A., Nakafero, G., Kuo, C.-F., Mallen, C., Zhang, W., Grainge, M. J., & 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. https://doi.org/10.1093/rheumatology/key013

• Journal Article Type: Article
• Acceptance Date: Jan 12, 2018
• Online Publication Date: Feb 23, 2018
• Publication Date: Jun 1, 2018
• Deposit Date: Feb 19, 2018
• Publicly Available Date: Feb 23, 2018
• Journal: Rheumatology
• Electronic ISSN: 1462-0324
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 57
• Issue: 6
• Pages: 977–981
• DOI: https://doi.org/10.1093/rheumatology/key013
• Keywords: Rheumatoid arthritis; Mortality; Temporal trends
• Public URL: https://nottingham-repository.worktribe.com/output/935115
• Publisher URL: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/key013/4904191
• Contract Date: Feb 19, 2018