Background/Purpose: Rheumatoid arthritis (RA) is a systemic autoimmune disease associated with increased morbidity and mortality. While treatments have evolved, national trends and sociodemographic disparities in RA-related mortality are poorly characterized. This study evaluates patterns in RA mortality over two decades, focusing on age, sex, race, geography, and place of death.

Methods: Mortality data for RA (ICD-10 code M06.9) from 1999–2020 were obtained from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using census-adjusted estimates. Data were stratified by year, state, age group (10-year intervals), sex, race/ethnicity, Hispanic origin, urbanization level (2013 classification), and place of death.

Results: Between 1999 and 2020, there were 47,075 deaths related to rheumatoid arthritis (RA) in the United States. The age-adjusted mortality rate (AAMR) declined significantly from 0.87 per 100,000 in 1999 to 0.42 in 2020, representing a 51.7% decrease. Women experienced 2.4 times higher mortality than men, with an AAMR of 0.84 compared to 0.35. Mortality increased steeply with age, peaking at 10.1 per 100,000 among those aged 85 and older. By race and ethnicity, American Indian/Alaska Native individuals had the highest AAMR (1.07), followed by White (0.66), Black (0.49), and Asian/Pacific Islander (0.31); Hispanic individuals had an AAMR of 0.52. Urbanization patterns revealed the lowest AAMR in large central metro areas (0.52) and the highest in noncore rural areas (0.81). Geographic variation showed state AAMRs ranging from 0.52 in California to 1.27 in Montana, with elevated rates in older, less urbanized states. In terms of place of death, most occurred in inpatient settings (40.4%) or nursing homes (26.6%), followed by the decedent’s home (23.2%), hospice facilities (2.6%), outpatient/ER (3.6%), and other locations.

Conclusion: RA-related mortality in the U.S. declined significantly from 1999 to 2020. However, persistent disparities by age, sex, race, urbanization, and place of death underscore the need for targeted public health and clinical strategies to improve equity in RA outcomes and end-of-life care.

Graphs showing state, demographic, gender, race, age groups, place of death, and yearly mortality from Rheumatoid Arthritis

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-mortality-in-the-u-s-1999-2020-a-decline-in-rates-but-not-in-disparities/