Background/Purpose: Pulmonary complications in rheumatoid arthritis (RA) are an important cause of mortality among older adults. This study analyzes trends and demographic disparities in mortality rates due to RA. Patients aged 65 and older from 1999 to 2020 in the United States were included in the study.

Methods: A retrospective analysis was conducted using the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and trends were assessed using Average Annual Percentage Change (AAPC) and Annual Percent Change (APC). Data were stratified by year, sex, race/ethnicity, and geographical regions.

Results: Between 1999 and 2020, pulmonary complications in RA accounted for 73,164 deaths among older adults aged 65+ in the U.S. Deaths primarily occurred in medical facilities (49.0%). The overall AAMR decreased from 10.7 in 1999 to 8.3 in 2020, with an AAPC of -1.13 (95% CI: -1.58 to -0.79, p < 0.000001). The AAMR significantly declined from 1999 to 2018 (APC: -2.43, p < 0.000001), followed by a dramatic rise from 2018 to 2020 (APC: 12.11, p = 0.0016). Older women had higher AAMRs than men (women: 9.6; men: 5.8), with both sexes experiencing decreases (men: AAPC: -2.34, p < 0.000001; women: AAPC: -0.82, p < 0.000001). Among racial groups, American Indian or Alaska Natives had the highest AAMRs (15.1), followed by Whites (8.6), Hispanics (6.6), Black Africans (5.1), and Asians/ Pacific Islanders (4.0). AAMRs decreased for all races except Black African patients, with the largest decrease in Asians (AAPC: -1.48, p = 0.002). Geographically, AAMRs ranged from 4.0 in Nevada to 14.9 in Vermont, with the highest mortality in the Midwestern and Western regions (both AAMR: 9.3). Nonmetropolitan areas had higher AAMRs than metropolitan areas (nonmetropolitan: 10.3; metropolitan: 7.5), with both areas showing decreases from 1999 to 2020 (metropolitan AAPC: -1.19, p < 0.000001; nonmetropolitan AAPC: -1.07, p < 0.000001).

Conclusion: This analysis shows a decline in mortality rates due to pulmonary complications in RA among older adults in the U.S. However, a recent increase has been observed. Significant demographic and geographic disparities were noted in the results, highlighting the need for targeted interventions to improve health outcomes in affected populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pulmonary-complications-and-mortality-trends-in-rheumatoid-arthritis-patients-aged-65-and-older-in-the-united-states-a-cdc-wonder-database-analysis/