Rheumatoid arthritis-ILD mortality remains stable despite fewer arthritis-related deaths
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Rheumatoid arthritis-related mortality rates are declining, but death rates related to rheumatoid arthritis-interstitial lung disease remain stable for adults younger than 65 years, researchers reported.
Niranjan Jeganathan, MD, MS, associate professor of medicine in the division of pulmonary, critical care, hyperbaric, allergy and sleep medicine and the department of medicine at Loma Linda University Health, California, and colleagues conducted a retrospective, population-based study of 36,067,309 deaths in the U.S. to describe RA and RA-ILD mortality rates and trends from 2005 to 2018.
“A recent study demonstrated stable incidence of rheumatoid arthritis-associated ILD in the U.S. but an increasing prevalence, suggesting improved survival. This prompted us to examine the current mortality rates and trends for rheumatoid arthritis and rheumatoid arthritis-associated ILD,” Jeganathan told Healio.
Utilizing the Multiple Cause of Death Database available through the CDC, 123,012 (0.34%) patients with RA were identified. Of these, 12,180 (9.9%) had RA-ILD. Researchers assessed the age-adjusted mortality rates and trends stratified by patient demographics.
The results, published in the Annals of the American Thoracic Society, found higher RA and RA-ILD mortality rates per 1,000,000 people among adults aged 65 to 74 (80.4 and 10.5), 75 to 84 (230.7 and 23.3) and 85 years and older (434.5 and 25.2). Rates were also higher among women (32.4 and 2.9) than men (16 and 2.1), although ILD prevalence was higher among men with RA compared with women (13.3% vs. 8.7%).
Researchers also observed higher RA mortality rates per 1,000,000 people among Native American and white adults (50.1 and 26.9). Hispanic adults had lower RA mortality rates per 1,000,000 people (20.4 vs. 26.9) but higher RA-ILD mortality rates (3.2 vs. 2.5) compared with white adults.
There was an overall decrease in RA mortality rates per 1,000,000 people from 30.6 in 2005 to 22.2 in 2018. These declines were observed for both men (19.6 vs. 13.8; P < .001) and women (38 vs. 28.3; P < .001) and all race/ethnicity and age groups.
However, RA-ILD mortality rates per 1,000,000 people remained stable among men and women, all races and every age group except for those aged 65 to 74 (11.1 vs. 8.6; P = .04) and 75 to 84 years (24.9 vs. 20.4; P = .004) where there was a decline from 2005 to 2018.
“Rheumatoid arthritis mortality rates in the U.S. decreased from 2005 to 2018, but in the presence of ILD the mortality rates remained stable. This suggests that the disease-modifying antirheumatic drugs and biologics may be of limited benefit in those with concomitant ILD,” Jeganathan told Healio.
According to Jeganathan, it was surprising that there was a lack of improvement in mortality rates for rheumatoid arthritis-associated ILD considering the overall improvement in rheumatoid arthritis mortality and comorbidity management.
“Prospective rheumatoid arthritis and ILD registries would help validate routine mortality data and allow investigators to assess whether changes in mortality rates are driven primarily by incidence or other factors such as genetics, environment and health care access,” Jeganathan said. “In addition, a validation study of death certification in the U.S. would be useful to explore the reliability of coding.”
For more information:
Niranjan Jeganathan, MD, MS, can be reached at njeganathan@llu.edu.