Background/Purpose: Studies on mortality in RA from Italy are completely lacking. The aim of our study was to investigate cause-specific mortality in RA subjects living in the Veneto Region (Italy).

Methods: We identified in the electronic archive of the Veneto Region patients aged 20Ð89 years who were exempt from copayment for RA in January 2010, and linked them with the archive of causes of deaths of the period 2010-2015. Causes of death were coded according to the International Classification of Diseases, 10th Edition. The selection of the underlying cause of death (UCOD) was performed by means of the Automated Classification of Medical Entities (US National Center for Health Statistics). Each subject was followed from 1st January 2010 either until death, or 90 years of age, or 31st December 2015, whichever came first. Standardized Mortality Ratios (SMRs) with 95% confidence intervals were computed as the ratios between deaths observed in the cohort, and those expected according to age- and gender-specific regional mortality rates.

Results: Overall 16,098 residents diagnosed with RA and aged 20-89 years were enrolled in the cohort (Figure 1). The overall follow-up amounted to 88,599 person-years, with 2,142 registered decedents. The most common causes of death were circulatory diseases (36.6%), neoplasms (24.2%), and respiratory diseases (8.3%). Overall SMR in RA subjects was 1.42 (1.36-1.48). Mortality was significantly increased from circulatory (SMR=1.56, 1.45-1.67), respiratory (SMR=1.83, 1.57-2.12), digestive (SMR=1.93, 1.60-2.32), infectious (SMR=2.34, 1.88-2.89), and hematological diseases (SMR=3.22, 2.04-4.83), and falls (SMR=1.95, 1.19-3.01) (Table I). Particularly SMR for circulatory diseases was higher in patients aged <65 years: SMR 1.86 (1.06-3.02) in males, and 2.07 (1.23-3.28) in females. RA was selected as the UOCD in 6.1% of all deaths in the cohort and was mentioned in 25.4% of death certificates. Diseases often reported in the certificate without being selected as the UCOD where sepsis, pneumonia, diabetes mellitus, and hypertensive diseases (Table II).

Conclusion : In the Veneto Region, a 42% excess risk of death was observed among subjects with RA compared to the general population. Adverse effects of therapy and comorbidities should be identified and adequately monitored in RA subjects.