Cause-Specific Mortality in Male US Veterans with Rheumatoid Arthritis

Bryant England, Harlan Sayles, Kaleb D Michaud, Liron Caplan, Lisa A. Davis, Grant W. Cannon, Brian C. Sauer, Elizabeth B. Solow, Andreas M. Reimold, Gail S. Kerr, Pascale Schwab, Josh F. Baker, Ted R Mikuls

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)36-45
Number of pages10
JournalArthritis Care and Research
Volume68
Issue number1
DOIs
StatePublished - Jan 1 2016

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Veterans
Rheumatoid Arthritis
Mortality
Cardiovascular Diseases
Confidence Intervals
Cause of Death
Rheumatoid Nodule
Survival
Rheumatoid Factor
Biological Factors
Prednisone
Methotrexate
Registries
Comorbidity
Neoplasms
Smoking

ASJC Scopus subject areas

  • Rheumatology

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Cause-Specific Mortality in Male US Veterans with Rheumatoid Arthritis. / England, Bryant; Sayles, Harlan; Michaud, Kaleb D; Caplan, Liron; Davis, Lisa A.; Cannon, Grant W.; Sauer, Brian C.; Solow, Elizabeth B.; Reimold, Andreas M.; Kerr, Gail S.; Schwab, Pascale; Baker, Josh F.; Mikuls, Ted R.

In: Arthritis Care and Research, Vol. 68, No. 1, 01.01.2016, p. 36-45.

Research output: Contribution to journalArticle

England, B, Sayles, H, Michaud, KD, Caplan, L, Davis, LA, Cannon, GW, Sauer, BC, Solow, EB, Reimold, AM, Kerr, GS, Schwab, P, Baker, JF & Mikuls, TR 2016, 'Cause-Specific Mortality in Male US Veterans with Rheumatoid Arthritis', Arthritis Care and Research, vol. 68, no. 1, pp. 36-45. https://doi.org/10.1002/acr.22642
England, Bryant ; Sayles, Harlan ; Michaud, Kaleb D ; Caplan, Liron ; Davis, Lisa A. ; Cannon, Grant W. ; Sauer, Brian C. ; Solow, Elizabeth B. ; Reimold, Andreas M. ; Kerr, Gail S. ; Schwab, Pascale ; Baker, Josh F. ; Mikuls, Ted R. / Cause-Specific Mortality in Male US Veterans with Rheumatoid Arthritis. In: Arthritis Care and Research. 2016 ; Vol. 68, No. 1. pp. 36-45.
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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.",
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AU - Sayles, Harlan

AU - Michaud, Kaleb D

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AU - Davis, Lisa A.

AU - Cannon, Grant W.

AU - Sauer, Brian C.

AU - Solow, Elizabeth B.

AU - Reimold, Andreas M.

AU - Kerr, Gail S.

AU - Schwab, Pascale

AU - Baker, Josh F.

AU - Mikuls, Ted R

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N2 - 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.

AB - 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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