Background/Purpose: Rheumatoid Arthritis (RA) is a chronic debilitating disease affecting up to 1% of the US population and has variable outcomes by race/ethnicity. We analyzed RA mortality by race/ethnicity to determine if racial/ethnic minority groups experience higher premature mortality.

Methods: We used the Centers for Disease Control and Prevention’s national mortality database to obtain death counts for RA in the United States for each year from 1999 to 2020 by race/ethnicity [non-Hispanic (NH) American Indian or Alaska Native (Native American), NH-Asian/Pacific Islander (A/PI), NH-black or African American (black), NH-white, and Hispanic or Latino (Hispanic)], age [≤44, 45-64 and ≥65 years], sex, and calendar year periods (1999-2009 and 2010-2020).  We calculated age-standardized mortality rates (ASMR) with 95% confidence interval (CI) by each of these variables. We analyzed trends in RA mortality by race/ethnicity and age over the 22-year period using Joinpoint regression trend analysis. We performed multiple regression analysis by race/ethnicity adjusting for age, sex, and calendar year periods, and then included interactions in the model to identify any effect modification among these variables. 

Results: There were 200,228 RA deaths from 1999 through 2020. The ASMR was the highest in Native Americans (5.14 per 100,000 persons, 95% CI, 4.91-5.38), followed by non-Hispanic (NH) whites (2.87, 95% CI, 2.86-2.88), NH-blacks (2.25, 95% CI, 2.21-2.29), Hispanics (2.15, 95% CI, 2.11-2.19), and NH-A/PIs (1.26, 95% CI, 1.21-1.30). Notably, the RA-ASMR was 10.8-fold higher at age ≤44, 3-fold at ages 45-64, and only 1.6-fold higher at ≥65 in Native American than in NH-whites. NH-blacks also had higher ASMR at ≤44 years but not at older ages relative to NH-whites. By age 65, significantly higher proportions of Native Americans died of RA relative to NH-whites (36% vs 14%, p< 0.01). Trend analysis showed that at age < 65 years, RA-ASMR significantly decreased from 1999 through 2018 in all race/ethnicities except in Native Americans. Multiple regression analysis revealed that the adjusted odds of death from RA was significantly higher (1.67, 95% CI 1.59-1.74, p< 0.001) in Native Americans but not in other race/ethnic groups relative to NH-whites. Significant interactions were detected for race/ethnicity–age and race/ethnicity–sex. Stratified analysis showed that the odds of RA death were significantly higher for Native Americans relative to NH-whites in both younger and older males and females; it was most profound in younger (< 65) females (odds ratio, 2.65, 95% CI 2.42-2.90) followed by younger males (1.56, 95% CI 1.33-1.83), older females, and older males.

Conclusion: RA mortality differs by race/ethnicity, with the highest premature mortality in Native Americans. Further investigations to understand the causes of these differences in premature mortality may help guide research and resource allocation to improve patient outcomes in the highest risk groups.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/native-americans-experience-profound-premature-mortality-from-rheumatoid-arthritis/