Survival in rheumatoid arthritis: A population-based analysis of trends over 40 years

Sherine E. Gabriel, Cynthia S. Crowson, Hilal Maradit Kremers, Michele F. Doran, Carl Turesson, W. Michael O'Fallon, Eric L. Matteson

Research output: Contribution to journalArticle

390 Citations (Scopus)

Abstract

Objective. To evaluate trends in and risk factors for mortality among patients with rheumatoid arthritis (RA) over a 40-year period. Methods. A population-based inception cohort was assembled from among all Rochester, Minnesota residents ages ≥18 years who were first diagnosed with RA (fulfilling the 1987 American College of Rheumatology criteria for RA) between January 1, 1955 and December 31, 1994. Patients were followed up longitudinally through their entire medical records (including all inpatient and outpatient care by any provider) until death or migration from the county. Survival was described using the Kaplan-Meier method. Observed and expected survival were compared using the log-rank test, and standardized mortality ratios (SMRs) with expected survival were based on the sex and age of the study population and death rates from the Minnesota life tables. Con proportional hazards models were used to estimate the influence of cop manifestations and comorbidities, controlling for age, sex, body mass index (BMI), smoking, and rheumatoid factor positivity. Results. Survival in this RA cohort was significantly lower than that expected in the population (P < 0.001) over the entire time period. Patients with RA were at significantly higher risk of death, with an SMR of 1.27 (95% confidence interval 1.13-1.41). Excess mortality among women was more pronounced than among men, with SMRs of 1.41 and 1.08, respectively. Presence of ≥1 cop manifestation was the strongest predictor of mortality after adjusting for age, sex, BMI, smoking, and rheumatoid factor positivity. Conclusion. Survival in RA patients is significantly lower than expected. The strongest predictors of survival appear to be those related to RA disease complications, specifically, cop manifestations of the disease and comorbidities. More attention should be paid to mortality as an outcome measure in RA.

Original languageEnglish (US)
Pages (from-to)54-58
Number of pages5
JournalArthritis and rheumatism
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2003

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Rheumatoid Arthritis
Survival
Mortality
Population
Rheumatoid Factor
Comorbidity
Body Mass Index
Smoking
Life Tables
Ambulatory Care
Proportional Hazards Models
Medical Records
Inpatients
Outcome Assessment (Health Care)
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

Cite this

Gabriel, S. E., Crowson, C. S., Kremers, H. M., Doran, M. F., Turesson, C., O'Fallon, W. M., & Matteson, E. L. (2003). Survival in rheumatoid arthritis: A population-based analysis of trends over 40 years. Arthritis and rheumatism, 48(1), 54-58. https://doi.org/10.1002/art.10705
Gabriel, Sherine E. ; Crowson, Cynthia S. ; Kremers, Hilal Maradit ; Doran, Michele F. ; Turesson, Carl ; O'Fallon, W. Michael ; Matteson, Eric L. / Survival in rheumatoid arthritis : A population-based analysis of trends over 40 years. In: Arthritis and rheumatism. 2003 ; Vol. 48, No. 1. pp. 54-58.
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abstract = "Objective. To evaluate trends in and risk factors for mortality among patients with rheumatoid arthritis (RA) over a 40-year period. Methods. A population-based inception cohort was assembled from among all Rochester, Minnesota residents ages ≥18 years who were first diagnosed with RA (fulfilling the 1987 American College of Rheumatology criteria for RA) between January 1, 1955 and December 31, 1994. Patients were followed up longitudinally through their entire medical records (including all inpatient and outpatient care by any provider) until death or migration from the county. Survival was described using the Kaplan-Meier method. Observed and expected survival were compared using the log-rank test, and standardized mortality ratios (SMRs) with expected survival were based on the sex and age of the study population and death rates from the Minnesota life tables. Con proportional hazards models were used to estimate the influence of cop manifestations and comorbidities, controlling for age, sex, body mass index (BMI), smoking, and rheumatoid factor positivity. Results. Survival in this RA cohort was significantly lower than that expected in the population (P < 0.001) over the entire time period. Patients with RA were at significantly higher risk of death, with an SMR of 1.27 (95{\%} confidence interval 1.13-1.41). Excess mortality among women was more pronounced than among men, with SMRs of 1.41 and 1.08, respectively. Presence of ≥1 cop manifestation was the strongest predictor of mortality after adjusting for age, sex, BMI, smoking, and rheumatoid factor positivity. Conclusion. Survival in RA patients is significantly lower than expected. The strongest predictors of survival appear to be those related to RA disease complications, specifically, cop manifestations of the disease and comorbidities. More attention should be paid to mortality as an outcome measure in RA.",
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Gabriel, SE, Crowson, CS, Kremers, HM, Doran, MF, Turesson, C, O'Fallon, WM & Matteson, EL 2003, 'Survival in rheumatoid arthritis: A population-based analysis of trends over 40 years', Arthritis and rheumatism, vol. 48, no. 1, pp. 54-58. https://doi.org/10.1002/art.10705

Survival in rheumatoid arthritis : A population-based analysis of trends over 40 years. / Gabriel, Sherine E.; Crowson, Cynthia S.; Kremers, Hilal Maradit; Doran, Michele F.; Turesson, Carl; O'Fallon, W. Michael; Matteson, Eric L.

In: Arthritis and rheumatism, Vol. 48, No. 1, 01.01.2003, p. 54-58.

Research output: Contribution to journalArticle

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T1 - Survival in rheumatoid arthritis

T2 - A population-based analysis of trends over 40 years

AU - Gabriel, Sherine E.

AU - Crowson, Cynthia S.

AU - Kremers, Hilal Maradit

AU - Doran, Michele F.

AU - Turesson, Carl

AU - O'Fallon, W. Michael

AU - Matteson, Eric L.

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N2 - Objective. To evaluate trends in and risk factors for mortality among patients with rheumatoid arthritis (RA) over a 40-year period. Methods. A population-based inception cohort was assembled from among all Rochester, Minnesota residents ages ≥18 years who were first diagnosed with RA (fulfilling the 1987 American College of Rheumatology criteria for RA) between January 1, 1955 and December 31, 1994. Patients were followed up longitudinally through their entire medical records (including all inpatient and outpatient care by any provider) until death or migration from the county. Survival was described using the Kaplan-Meier method. Observed and expected survival were compared using the log-rank test, and standardized mortality ratios (SMRs) with expected survival were based on the sex and age of the study population and death rates from the Minnesota life tables. Con proportional hazards models were used to estimate the influence of cop manifestations and comorbidities, controlling for age, sex, body mass index (BMI), smoking, and rheumatoid factor positivity. Results. Survival in this RA cohort was significantly lower than that expected in the population (P < 0.001) over the entire time period. Patients with RA were at significantly higher risk of death, with an SMR of 1.27 (95% confidence interval 1.13-1.41). Excess mortality among women was more pronounced than among men, with SMRs of 1.41 and 1.08, respectively. Presence of ≥1 cop manifestation was the strongest predictor of mortality after adjusting for age, sex, BMI, smoking, and rheumatoid factor positivity. Conclusion. Survival in RA patients is significantly lower than expected. The strongest predictors of survival appear to be those related to RA disease complications, specifically, cop manifestations of the disease and comorbidities. More attention should be paid to mortality as an outcome measure in RA.

AB - Objective. To evaluate trends in and risk factors for mortality among patients with rheumatoid arthritis (RA) over a 40-year period. Methods. A population-based inception cohort was assembled from among all Rochester, Minnesota residents ages ≥18 years who were first diagnosed with RA (fulfilling the 1987 American College of Rheumatology criteria for RA) between January 1, 1955 and December 31, 1994. Patients were followed up longitudinally through their entire medical records (including all inpatient and outpatient care by any provider) until death or migration from the county. Survival was described using the Kaplan-Meier method. Observed and expected survival were compared using the log-rank test, and standardized mortality ratios (SMRs) with expected survival were based on the sex and age of the study population and death rates from the Minnesota life tables. Con proportional hazards models were used to estimate the influence of cop manifestations and comorbidities, controlling for age, sex, body mass index (BMI), smoking, and rheumatoid factor positivity. Results. Survival in this RA cohort was significantly lower than that expected in the population (P < 0.001) over the entire time period. Patients with RA were at significantly higher risk of death, with an SMR of 1.27 (95% confidence interval 1.13-1.41). Excess mortality among women was more pronounced than among men, with SMRs of 1.41 and 1.08, respectively. Presence of ≥1 cop manifestation was the strongest predictor of mortality after adjusting for age, sex, BMI, smoking, and rheumatoid factor positivity. Conclusion. Survival in RA patients is significantly lower than expected. The strongest predictors of survival appear to be those related to RA disease complications, specifically, cop manifestations of the disease and comorbidities. More attention should be paid to mortality as an outcome measure in RA.

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