Background/Purpose: Rheumatoid arthritis (RA) is associated with an excess of mortality. This risk depends on the disease activity, severity and associated comorbidities. Our objective was to study the mortality profile of RA patients in France using multiple-cause-of-death analysis.

Methods: Data were collected between 2000 and 2011 in the French Epidemiological Center for the Medical Causes of Death database, and death certificates issued upon the death of an adult for whom RA was an underlying cause of death (UCD) or an associated cause of death (ACD) were evaluated using multiple-cause-of-death analysis. Sex, age, sex ratio, standardized mortality rates, as well as frequency of the various causes of death were assessed. For the main causes of death, the observed number of deaths in relation to the expected number of deaths (O/E ratio) was calculated to measure the strength of association between RA listed as an ACD and the corresponding UCD.

Results: During the study period, 13,208 deaths related to RA were identified. RA was identified as the UCD in 4597 (35%) certificates. The number of certificates mentioning RA as the UCD decreased from 41% to 27% between 2000 and 2011. The mean±SD at death was 79 ± 9 years (51% with ≥80 years). The female: male ratio was 3.2 and remained stable during the follow-up period. This ratio was significantly higher in the population where RA was the UCD (4.1 vs. 2.8 p <0.001). The mean standardized mortality rate was 0.25 per 10⁵ million people (range 0.21-0.28), and remained stable throughout the period. When RA was the UCD (n=4,597), the main ACDs were cardiovascular diseases (29%), infectious diseases (22%), and respiratory diseases (17%). When RA was an ACD (n=8,611), the most common UCDs were cardiovascular diseases (35% of certificates, including 877/3032 ischemic heart disease), neoplasms (14%), respiratory disease (9%) and infectious diseases (7%). The overall O/E ratio was >1 for infectious (3.58), respiratory (1.38) and cardiovascular diseases (1.25), but was <1 for neoplasms.

Conclusion: This is the first national study using a multiple-cause-of-death analysis to study the mortality profile in RA. Our results show that mortality related to cardiovascular, respiratory and infectious diseases is highly associated with RA. These data support the need to expand new strategies to prevent infectious and cardiovascular diseases in order to improve survival of RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mortality-profile-of-patients-with-rheumatoid-arthritis-in-france-and-its-change-in-10-years/