Key result
Incident rheumatoid arthritis was associated with increased total mortality (HR 1.46; 95% CI 1.32-1.62), which was substantially attenuated after adjusting for postdiagnosis multimorbidity (HR 1.18).
Why the study?
It was unclear how postdiagnosis multimorbidity and lifestyle changes contribute to the excess mortality seen in rheumatoid arthritis.
Does incident rheumatoid arthritis increase the risk of total, cardiovascular, and respiratory mortality in women, and is this mediated by postdiagnosis multimorbidity and lifestyle changes?
Cohort (n=11,077)
Does incident rheumatoid arthritis increase the risk of total, cardiovascular, and respiratory mortality in women, and is this mediated by postdiagnosis multimorbidity and lifestyle changes?
Hazard Ratio: 1.46 (95% CI 1.32–1.62)
Postdiagnosis accumulation of multimorbidity substantially accounts for the excess total and cardiovascular mortality observed in women with rheumatoid arthritis.
Multimorbidity largely mediates RA mortality excess; hypothesis-generating for targeted interventions, should not yet change practice.
OBJECTIVE: To elucidate how postdiagnosis multimorbidity and lifestyle changes contribute to the excess mortality of rheumatoid arthritis (RA). METHODS: We performed a matched cohort study among women in the Nurses' Health Study (1976-2018). We identified women with incident RA and matched each by age and year to 10 non-RA comparators at the RA diagnosis index date. Specific causes of death were ascertained via death certificates and medical record review. Lifestyle and morbidity factors were reported biennially; 61 chronic conditions were combined into the Multimorbidity Weighted Index (MWI). After adjusting for baseline confounders, we used inverse probability weighting analysis to examine the mediating influence of postindex MWI scores and lifestyle factors on total, cardiovascular, and respiratory mortality, comparing women with RA to their matched comparators. RESULTS: We identified 1,007 patients with incident RA and matched them to 10,070 non-RA comparators. After adjusting for preindex confounders, we found that hazard ratios (HRs) and 95% confidence intervals (95% CIs) were higher for total mortality (HR 1.46 [95% CI 1.32, 1.62]), as well as cardiovascular (HR 1.54 [95% CI 1.22, 1.94]) and respiratory (HR 2.75 [95% CI 2.05, 3.71]) mortality in patients with RA compared to non-RA comparators. Adjusting for postindex lifestyle factors (physical activity, body mass index, diet, smoking) attenuated but did not substantially account for this excess RA mortality. After additional adjustment for postindex MWI scores, patients with RA had HRs of 1.18 (95% CI 1.05, 1.32) for total, 1.19 (95% CI 0.94, 1.51) for cardiovascular, and 1.93 (95% CI 1.42, 2.62) for respiratory mortality. CONCLUSION: We found that MWI scores substantially accounted for the excess total and cardiovascular mortality among women with RA. This finding underscores the importance of monitoring for the total disease burden as a whole in monitoring patients with RA.
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Yoshida et al. (2019) conducted a cohort in Rheumatoid arthritis (n=11,077). Incident rheumatoid arthritis vs. Non-RA comparators was evaluated on Total mortality (HR 1.46, 95% CI 1.32, 1.62). Incident rheumatoid arthritis was associated with increased total mortality (HR 1.46; 95% CI 1.32-1.62), which was substantially attenuated after adjusting for postdiagnosis multimorbidity (HR 1.18).
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