Cause‐Specific Mortality in Male US Veterans With Rheumatoid Arthritis

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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. CVD (31.6%; SMR 1.77, 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) were the leading causes of death. Factors associated with all‐cause mortality included older age, Caucasian race, smoking, low body weight, comorbidity, disease activity, and prednisone use. Rheumatoid factor concentration was associated with CVD mortality, while nodules were associated with CVD and respiratory mortality. There were no associations of methotrexate or biologic use with all‐cause or cause‐specific mortality. Conclusions. 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 to examine whether interventions targeting potentially “modifiable” correlates of mortality might lead to improved long‐term survival in men with RA.
Funding Information
  • Rheumatology Research Foundation Resident Research Preceptorship
  • Rheumatology Research Foundation Investigator Award
  • Rheumatology Research Foundation Scientific Development Award
  • Veterans Affairs Merit Award

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