Rheumatoid arthritis and mortality. A longitudinal study in pima indians

Authors

  • LENNART T. H. Jacobsson MD, PhD, NIAMS,

    Corresponding author
    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
    Current affiliation:
    1. Lund University, Malmö, Sweden
    • Department of Internal Medicine, Section of Rheumatology, S-21401 Malmö, Sweden
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  • William C. Knowler MD, DrPh,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • Stanley Pillemer MD, NIAMS,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • Robert L. Hanson MD, MPH,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • David J. Pettitt MD,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • Robert G. Nelson MD, MPH,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • Antonio Del Puente MD,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • David R. Mccance MD, MRCP,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • Marie-Aline Charles MD, MPH,

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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  • Peter H. Bennett MB, FRCP, FFCM

    1. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona, and Bethesda, Maryland; the Diabetes and Arthritis Epidemiology Section, National Institute of Diabetes and Digestive and Kidney Diseases, and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Phoenix, Arizona and the Department of Rheumatology, University of Naples, Naples, Italy.
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Abstract

Objective. To determine the effect of rheumatoid arthritis (RA) on mortality rates.

Methods. Longitudinal analyses of data from a cohort of Pima Indians from the Gila River Indian Community in Arizona, who were followed up during the period February 1965 through December 1989.

Results. Among 2,979 study subjects aged ≤25 years, there were 858 deaths, 79 of which occurred in subjects with RA (36 men, 43 women). Age and sex-adjusted mortality rates were slightly higher in subjects with RA than in those without (mortality rate ratio 1.28, 95% confidence interval [95% CI] 1.01–1.62). Among those with RA, mortality rates were higher in older subjects (mortality rate ratio 1.51 per 10-year increase in age, 95% CI 1.22–1.88), in male subjects (mortality rate ratio 2.23, 95% CI 1.44–3.45, adjusted for age), and in subjects with proteinuria (mortality rate ratio 1.88, 95% CI 1.02–3.46, adjusted for age and sex). Mortality rate ratios for these risk factors were similar in subjects without RA. In addition, among subjects with RA, rheumatoid factor (RF) positivity was predictive of death (mortality rate ratio 1.94, 95% CI 1.10–3.43), and the excess mortality was found primarily among subjects who were seropositive. The death rate from cardiovascular disease (mortality rate ratio 1.77, 95% CI 1.10–2.84) and from liver cirrhosis or other alcohol-related disease (mortality rate ratio 2.52, 95% CI 1.06–6.01) was increased in persons with RA.

Conclusion. The results of this population-based study suggest that although the risk of mortality in subjects with RA is significantly higher than in those without RA, the risk ratio is in the lower range of that described previously in studies of clinic-based cohorts. RF positivity as a predictor of early death among subjects with RA indicates that the immunologic processes in seropositive RA may contribute to the events that eventually lead to early death.

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