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RA mortality rising despite decline for other rheumatologic diseases
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DESTIN, Fla. — Rheumatoid arthritis demonstrated a statistically significant increase in mortality between 2005 and 2015, bucking a downward trend for mortality in most other rheumatologic diseases, according to findings from a national study presented at the North American Young Rheumatology Investigator Forum.
“There have been many advances in diagnostics, treatments and awareness in the field of rheumatology in the past couple decades, and we can see that by several of the commercials for biologics on television,” Rouhin Sen, MD, of the Creighton University Medical Center, told attendees. “However, in our literature search, we did not find any comprehensive nationwide analysis of inpatient mortality for many rheumatologic diseases.”
To provide a nationwide analysis of mortality trends for a variety of rheumatologic conditions, as well as to compare mortality rates between academic and nonacademic urban centers, and to evaluate the average age of death among the diseases, Sen and colleagues drew data from the National Inpatient Sample (NIS). The researchers focused on patients with confirmed diagnoses of crystal arthropathies, seronegative spondyloarthropathies, systemic sclerosis, systemic lupus erythematosus (SLE), RA, antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis and giant cell arteritis (GCA).
The researchers identified 13,433,852 hospitalizations related to the above conditions, and analyzed age-adjusted mortality as an annual trend from 2002 to 2014. In addition, they compared overall mortality during that time period between academic teaching status for urban hospitals with the Rao-Scott Chi-square test. Mean mortality ages were determined for each condition. Analyses accounted for the NIS’ sampling design.
According to Sen, all of the rheumatologic conditions included in the study demonstrated statistically significant decreases in mortality during the study period, with a -2.33% annual percent change (APC) (P = .001), except for RA and crystal arthropathies. RA showed a 2.27% APC increase in mortality (P < .001), while crystal arthropathies demonstrated no statistically significant change. In addition, with the exception of RA and ANCA-associated vasculitis, the examined rheumatologic conditions demonstrated no significant differences in mortality among academic and nonacademic centers.
Sen added that the average age of mortality ranged from 56.9 years for reactive arthritis, to 59.6 years for SLE and 74.6 years for RA.
“RA, unlike all the other diseases, showed an upward trend, although not every study shows this trend. Some studies have showed a decline in mortality,” Sen said. “However, for the purposes of our study, we thought this increase may be due to complications from treatments with biologics, such as infections. There have been some, albeit controversial, papers that have shown that biologics can increase risks for interstitial lung disease. However, on the other hand, biologics are also thought to decrease cardiovascular risk, so we are unsure.” – by Jason Laday
Reference:Sen R. Mortality in selected rheumatologic diseases using the national inpatient sample (NIS) from 2002 to 2014: Trends, impact of academic hospital teaching status and average age of mortaility. Presented at: North American Young Rheumatology Investigator Forum; May 16, 2018; Destin, Fla.
Disclosure: Sen reports no relevant financial disclosures.