Funding: The project was funded by an Arthritis Foundation of Australia Grant-in-Aid, a National Health and Medical Research Council Scholarship, an Arthritis Foundation of Australia Scholarship and a Commonwealth of Australia National Musculoskeletal Health Priority Grant.
How many life years are lost in patients with rheumatoid arthritis? Secular cause-specific and all-cause mortality in rheumatoid arthritis, and their predictors in a long-term Australian cohort study
Version of Record online: 17 JAN 2013
© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 43, Issue 1, pages 66–72, January 2013
How to Cite
Lassere, M. N., Rappo, J., Portek, I. J., Sturgess, A. and Edmonds, J. P. (2013), How many life years are lost in patients with rheumatoid arthritis? Secular cause-specific and all-cause mortality in rheumatoid arthritis, and their predictors in a long-term Australian cohort study. Internal Medicine Journal, 43: 66–72. doi: 10.1111/j.1445-5994.2012.02727.x
Conflict of interest: None.
- Issue online: 17 JAN 2013
- Version of Record online: 17 JAN 2013
- Accepted manuscript online: 31 JAN 2012 06:53AM EST
- Manuscript Accepted: 16 JAN 2012
- Manuscript Received: 13 JUN 2011
- Arthritis Foundation of Australia Grant-in-Aid
- National Health and Medical Research Council Scholarship
- Arthritis Foundation of Australia Scholarship
- Commonwealth of Australia National Musculoskeletal Health Priority Grant
- rheumatoid arthritis;
There is an excess of mortality in patients with rheumatoid arthritis (RA) but no long-term Australian cohort data.
To determine median life years lost, all-cause standardised mortality ratio (SMR) and cause-specific SMR, their predictors and secular change in Australian patients with RA.
Study population was all patients seen by a rheumatologist between 1990 and 1994. Record linkage with Australian National Death Index was performed to determine fact and cause of death up to 2004. All-cause and cause-specific SMR, and median life years lost were determined.
There were 35 (31%) deaths in the early 1990s cohort (n = 113), SMR 1.31 (95% 0.93, 1.80). There were 216 (44%) deaths in the pre-1990s established cohort (n = 495), SMR 1.73 (1.49, 1.95). Median life years lost in the early cohort was 6 years for males and 7 years for females compared with 8 and 10 years, respectively, in the established cohort. Patients with low disease activity score at baseline (DAS < 3.2), SMR was 0.8 (0.3, 2.2) and 1.5 (1.1, 2.2) for the early and established cohorts, and if DAS ≥3.2, SMR was 1.4 (1.02, 1.98) and 1.8 (1.5, 2.1) respectively. Primary cause of death was cardiovascular disease (SMR 1.43 (1.17, 1.74). Patients at most risk were those age 45–54 years. RA was listed as a comorbid condition on the death certificate in only 16% of patients.
Within a period of 14 years, median life expectancy of patients with RA with disease onset in the early 1990s is reduced by 6–7 years. However, our results also suggest a secular reduction in excess mortality.