Patients disabled with RA have 23% higher CVD risk than those considered employable
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Patients with rheumatoid arthritis who are on Social Security Disability Insurance have a 23% higher risk for cardiovascular disease compared with those considered employable, according to data published in Arthritis Research & Therapy.
“Despite the risk of becoming disabled that still exists among patients with musculoskeletal conditions, such as RA, there is limited data regarding the CVD outcomes among beneficiaries of the [Social Security Disability Insurance (SSDI)],” Iris Navarro-Millan, MD, of the division of general internal medicine at Weill Cornell Medicine, and the division of rheumatology at the Hospital for Special Surgery, in New York, and colleagues wrote. “CVD risk estimation across diverse RA cohorts may be challenging given the potential heterogeneity in comorbidities and widely varying prevalence of CVD risk factors.”
To investigate the risk for cardiovascular diseases among patients with RA receiving SSDI benefits, compared with those on commercial insurance, Navarro-Millan and colleagues conducted a retrospective, longitudinal analysis of data from 2006 through 2016. The analysis consisted of six cohorts, three of which used data from SSDI beneficiaries and three from patients enrolled in Marketscan, a health care research database. Patients in all cohorts were aged 40 to 65 years.
Cohorts were defined uniformly for each dataset. In the first cohort, patients demonstrated two or more diagnosis codes for RA, with a span of 7 through 365 days between diagnoses. At least one diagnosis code was required to have come from a rheumatologist. The second included patients who had one or more diagnosis code for RA, as well as documented use of disease-modifying antirheumatic drugs. Meanwhile, the third cohort featured all the requirements of cohort two, plus initiation of a new biologic DMARD or tofacitinib.
Patients were excluded if they had other autoimmune diseases, malignancy, HIV or a history of myocardial infarction or stroke. Main outcomes included myocardial infarction and stroke.
A total of 380,336 patients with RA, with an average age of 53 years, were included in the analysis. Overall, there was a higher rate of comorbidities among patients on SSDI, compared with those on commercial insurance, according to the researchers. In the second cohort, including patients receiving a DMARD for therapy, patients receiving SSDI demonstrated a higher risk for CVD (HR = 1.23; 95% CI, 1.14-1.33), compared with those on commercial insurance. There was no statistically significant difference in CVD risk in the third cohort.
“This investigation is among the first to examine the risk of CVD events among beneficiaries of the SSDI and individuals disabled with RA, compared with similarly aged working patients with RA,” Navarro-Millan and colleagues wrote. “Middle-aged patients with RA and beneficiaries of the SSDI had higher rates for CVD events compared with middle-aged individuals with RA who were privately insured (likely to be currently employed).”
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