Premature death from rheumatoid arthritis in Native Americans has not improved in 20 years
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WASHINGTON — High rates of premature mortality from rheumatoid arthritis among Native American populations have seen no change in the past 20 years, while other races have demonstrated improving trends, according to data.
“Many people with rheumatoid arthritis die at younger ages from cardiovascular, respiratory, cancer and infectious causes,” Parmita Das, of the University of California, Los Angeles, told attendees at ACR Convergence 2024. “Previous studies have shown that RA causes increased mortality, with a standardized mortality ratio of 1.1 to 3. However, these studies have been done in referral center cohorts, which do not represent the mortality burden in the general population.”
For a population-based analysis of RA mortality trends by race and ethnicity, Das and colleagues examined data on 200,228 RA deaths from 1999 through 2020 in the CDC’s Multiple Causes of Death database.
The researchers calculated age-standardized mortality rates based on race, ethnicity and age. The effects of these variables were then estimated using multiple regression analysis. Mortality trends by race and ethnicity over time were also analyzed using join point regression trend analysis.
Across the study period, non-Hispanic American Indians and Alaska Natives demonstrated the highest age-standardized mortality rate, at 5.14 per 100,000 persons (95% CI, 4.91-5.38), with non-Hispanic whites having the next highest, at 2.15 (95% CI, 2.11-2.19), according to the researchers.
Meanwhile, using joinpoint analysis, the researchers found greater than 2% decreases in mortality each year for white, Black and Hispanic patients, until roughly the time of the COVID-19 pandemic. However, there was never any significant decrease in mortality for Native American populations throughout the study period.
Younger Native American patients appeared to be at particularly higher risk, according to the researchers. Compared with non-Hispanic whites of similar age, mortality rates were 10.8-fold higher among Native Americans aged younger than 44 years, and three-fold higher among those aged 45 to 64 years.
To determine whether these rates had changed over the study period, the researchers again used join point analysis.
“The RA mortality at older ages significantly did decrease for all of the racial ethnic groups,” Das said. “However, when we look at it for younger ages, you can see a decrease in all of the racial ethnic groups, except in Native Americans. RA mortality never decreased significantly over the past 22 years for younger Native Americans.
“This high premature mortality in Native Americans calls for urgent action, for focused research and resource allocation,” Das added. “Specifically we need to look at causes — socioenvironmental, biologic or a combination of both, focusing on things like income and poverty, health insurance, education, access to care, and also looking at whether excess premature mortality affects certain tribes or in certain locations.”
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Das P. Abstract #1747. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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