Bryant R England1, Harlan Sayles1, Kaleb Michaud2, Liron Caplan3, Lisa A Davis4, Grant W Cannon5, Brian C Sauer5, Elizabeth B Solow6, Andreas M Reimold6, Gail S Kerr7, Pascale Schwab8, Josh F Baker9, Ted R Mikuls1. 1. Veterans Affairs Nebraska-Western Iowa Health Care System, and University of Nebraska Medical Center, Omaha. 2. Veterans Affairs Nebraska-Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas. 3. Denver VAMC and University of Colorado, Denver. 4. Denver VAMC, University of Colorado, and Denver Health Medical Center, Denver, Colorado. 5. Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City. 6. Dallas Veterans Affairs and University of Texas Southwestern, Dallas. 7. Washington, DC, Veterans Affairs Medical Center and Georgetown and Howard Universities, Washington, DC. 8. Portland Veterans Affairs Health Care System and Oregon Health and Sciences University, Portland. 9. Philadelphia VAMC and University of Pennsylvania School of Medicine, Philadelphia.
Abstract
OBJECTIVE: There has been limited investigation into cause-specific mortality and the associated risk factors in men with rheumatoid arthritis (RA). We investigated all-cause and cause-specific mortality in men with RA, examining determinants of survival. METHODS: Men from a longitudinal RA registry were followed from enrollment until death or through 2013. Vital status and cause of death were determined using the National Death Index. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all-cause, cardiovascular disease (CVD), cancer, and respiratory mortality. Associations with all-cause and cause-specific mortality were examined using multivariable Cox proportional hazards and competing-risks regression. RESULTS: There were 1,652 men with RA and 332 deaths. The leading causes of death were CVD (31.6%; SMR 1.77 [95% confidence interval (95% CI) 1.46-2.14]), cancer (22.9%; SMR 1.50 [95% CI 1.20-1.89]), and respiratory disease (15.1%; SMR 2.90 [95% CI 2.20-3.83]). Factors associated with all-cause mortality included older age, white race, smoking, low body weight, comorbidity, disease activity, and prednisone use. Rheumatoid factor concentration and nodules were associated with CVD mortality. There were no associations of methotrexate or biologic agent use with all-cause or cause-specific mortality. CONCLUSION: Men in this RA cohort experienced increased all-cause and cause-specific mortality, with a 3-fold risk of respiratory-related deaths compared to age-matched men in the general population. Further studies are needed in order to examine whether interventions targeting potentially modifiable correlates of mortality might lead to improved long-term survival in men with RA.
OBJECTIVE: There has been limited investigation into cause-specific mortality and the associated risk factors in men with rheumatoid arthritis (RA). We investigated all-cause and cause-specific mortality in men with RA, examining determinants of survival. METHODS:Men from a longitudinal RA registry were followed from enrollment until death or through 2013. Vital status and cause of death were determined using the National Death Index. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all-cause, cardiovascular disease (CVD), cancer, and respiratory mortality. Associations with all-cause and cause-specific mortality were examined using multivariable Cox proportional hazards and competing-risks regression. RESULTS: There were 1,652 men with RA and 332 deaths. The leading causes of death were CVD (31.6%; SMR 1.77 [95% confidence interval (95% CI) 1.46-2.14]), cancer (22.9%; SMR 1.50 [95% CI 1.20-1.89]), and respiratory disease (15.1%; SMR 2.90 [95% CI 2.20-3.83]). Factors associated with all-cause mortality included older age, white race, smoking, low body weight, comorbidity, disease activity, and prednisone use. Rheumatoid factor concentration and nodules were associated with CVD mortality. There were no associations of methotrexate or biologic agent use with all-cause or cause-specific mortality. CONCLUSION:Men in this RA cohort experienced increased all-cause and cause-specific mortality, with a 3-fold risk of respiratory-related deaths compared to age-matched men in the general population. Further studies are needed in order to examine whether interventions targeting potentially modifiable correlates of mortality might lead to improved long-term survival in men with RA.
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Authors: Bryant R England; Joshua F Baker; Harlan Sayles; Kaleb Michaud; Liron Caplan; Lisa A Davis; Grant W Cannon; Brian C Sauer; E Blair Solow; Andreas M Reimold; Gail S Kerr; Ted R Mikuls Journal: Arthritis Care Res (Hoboken) Date: 2017-12-06 Impact factor: 4.794
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