Rheumatoid arthritis and mortality. A longitudinal study in pima indians

Objective. To determine the effect of rheumatoid arthritis (RA) on mortality rates. Methods. Longitudinal analyses of data from a cohort of Pima Indians from the Gila River Indian Community in Arizona, who were followed up during the period February 1965 through December 1989. Results. Among 2,979 s...

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Veröffentlicht in:Arthritis and rheumatism 1993-08, Vol.36 (8), p.1045-1053
Hauptverfasser: Jacobsson, LENNART T. H., Knowler, William C., Pillemer, Stanley, Hanson, Robert L., Pettitt, David J., Nelson, Robert G., Puente, Antonio Del, Mccance, David R., Charles, Marie‐Aline, Bennett, Peter H.
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container_end_page 1053
container_issue 8
container_start_page 1045
container_title Arthritis and rheumatism
container_volume 36
creator Jacobsson, LENNART T. H.
Knowler, William C.
Pillemer, Stanley
Hanson, Robert L.
Pettitt, David J.
Nelson, Robert G.
Puente, Antonio Del
Mccance, David R.
Charles, Marie‐Aline
Bennett, Peter H.
description Objective. To determine the effect of rheumatoid arthritis (RA) on mortality rates. Methods. Longitudinal analyses of data from a cohort of Pima Indians from the Gila River Indian Community in Arizona, who were followed up during the period February 1965 through December 1989. Results. Among 2,979 study subjects aged ≤25 years, there were 858 deaths, 79 of which occurred in subjects with RA (36 men, 43 women). Age and sex‐adjusted mortality rates were slightly higher in subjects with RA than in those without (mortality rate ratio 1.28, 95% confidence interval [95% CI] 1.01–1.62). Among those with RA, mortality rates were higher in older subjects (mortality rate ratio 1.51 per 10‐year increase in age, 95% CI 1.22–1.88), in male subjects (mortality rate ratio 2.23, 95% CI 1.44–3.45, adjusted for age), and in subjects with proteinuria (mortality rate ratio 1.88, 95% CI 1.02–3.46, adjusted for age and sex). Mortality rate ratios for these risk factors were similar in subjects without RA. In addition, among subjects with RA, rheumatoid factor (RF) positivity was predictive of death (mortality rate ratio 1.94, 95% CI 1.10–3.43), and the excess mortality was found primarily among subjects who were seropositive. The death rate from cardiovascular disease (mortality rate ratio 1.77, 95% CI 1.10–2.84) and from liver cirrhosis or other alcohol‐related disease (mortality rate ratio 2.52, 95% CI 1.06–6.01) was increased in persons with RA. Conclusion. The results of this population‐based study suggest that although the risk of mortality in subjects with RA is significantly higher than in those without RA, the risk ratio is in the lower range of that described previously in studies of clinic‐based cohorts. RF positivity as a predictor of early death among subjects with RA indicates that the immunologic processes in seropositive RA may contribute to the events that eventually lead to early death.
doi_str_mv 10.1002/art.1780360804
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Among 2,979 study subjects aged ≤25 years, there were 858 deaths, 79 of which occurred in subjects with RA (36 men, 43 women). Age and sex‐adjusted mortality rates were slightly higher in subjects with RA than in those without (mortality rate ratio 1.28, 95% confidence interval [95% CI] 1.01–1.62). Among those with RA, mortality rates were higher in older subjects (mortality rate ratio 1.51 per 10‐year increase in age, 95% CI 1.22–1.88), in male subjects (mortality rate ratio 2.23, 95% CI 1.44–3.45, adjusted for age), and in subjects with proteinuria (mortality rate ratio 1.88, 95% CI 1.02–3.46, adjusted for age and sex). Mortality rate ratios for these risk factors were similar in subjects without RA. In addition, among subjects with RA, rheumatoid factor (RF) positivity was predictive of death (mortality rate ratio 1.94, 95% CI 1.10–3.43), and the excess mortality was found primarily among subjects who were seropositive. The death rate from cardiovascular disease (mortality rate ratio 1.77, 95% CI 1.10–2.84) and from liver cirrhosis or other alcohol‐related disease (mortality rate ratio 2.52, 95% CI 1.06–6.01) was increased in persons with RA. Conclusion. The results of this population‐based study suggest that although the risk of mortality in subjects with RA is significantly higher than in those without RA, the risk ratio is in the lower range of that described previously in studies of clinic‐based cohorts. 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H.</creatorcontrib><creatorcontrib>Knowler, William C.</creatorcontrib><creatorcontrib>Pillemer, Stanley</creatorcontrib><creatorcontrib>Hanson, Robert L.</creatorcontrib><creatorcontrib>Pettitt, David J.</creatorcontrib><creatorcontrib>Nelson, Robert G.</creatorcontrib><creatorcontrib>Puente, Antonio Del</creatorcontrib><creatorcontrib>Mccance, David R.</creatorcontrib><creatorcontrib>Charles, Marie‐Aline</creatorcontrib><creatorcontrib>Bennett, Peter H.</creatorcontrib><title>Rheumatoid arthritis and mortality. A longitudinal study in pima indians</title><title>Arthritis and rheumatism</title><addtitle>Arthritis Rheum</addtitle><description>Objective. To determine the effect of rheumatoid arthritis (RA) on mortality rates. Methods. Longitudinal analyses of data from a cohort of Pima Indians from the Gila River Indian Community in Arizona, who were followed up during the period February 1965 through December 1989. Results. Among 2,979 study subjects aged ≤25 years, there were 858 deaths, 79 of which occurred in subjects with RA (36 men, 43 women). Age and sex‐adjusted mortality rates were slightly higher in subjects with RA than in those without (mortality rate ratio 1.28, 95% confidence interval [95% CI] 1.01–1.62). Among those with RA, mortality rates were higher in older subjects (mortality rate ratio 1.51 per 10‐year increase in age, 95% CI 1.22–1.88), in male subjects (mortality rate ratio 2.23, 95% CI 1.44–3.45, adjusted for age), and in subjects with proteinuria (mortality rate ratio 1.88, 95% CI 1.02–3.46, adjusted for age and sex). Mortality rate ratios for these risk factors were similar in subjects without RA. In addition, among subjects with RA, rheumatoid factor (RF) positivity was predictive of death (mortality rate ratio 1.94, 95% CI 1.10–3.43), and the excess mortality was found primarily among subjects who were seropositive. The death rate from cardiovascular disease (mortality rate ratio 1.77, 95% CI 1.10–2.84) and from liver cirrhosis or other alcohol‐related disease (mortality rate ratio 2.52, 95% CI 1.06–6.01) was increased in persons with RA. Conclusion. The results of this population‐based study suggest that although the risk of mortality in subjects with RA is significantly higher than in those without RA, the risk ratio is in the lower range of that described previously in studies of clinic‐based cohorts. 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H. ; Knowler, William C. ; Pillemer, Stanley ; Hanson, Robert L. ; Pettitt, David J. ; Nelson, Robert G. ; Puente, Antonio Del ; Mccance, David R. ; Charles, Marie‐Aline ; Bennett, Peter H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4094-544474e28fb807a98d8d3395ed60b66215d1e0936d6625bb7fe8c2fc712dc4673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Arizona - epidemiology</topic><topic>Arthritis, Rheumatoid - blood</topic><topic>Arthritis, Rheumatoid - epidemiology</topic><topic>Arthritis, Rheumatoid - mortality</topic><topic>Arthritis, Rheumatoid - urine</topic><topic>Biological and medical sciences</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Humans</topic><topic>Indians, North American</topic><topic>Inflammatory joint diseases</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Proteinuria - epidemiology</topic><topic>Rheumatoid Factor - blood</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Tropical medicine</topic><toplevel>online_resources</toplevel><creatorcontrib>Jacobsson, LENNART T. 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H.</au><au>Knowler, William C.</au><au>Pillemer, Stanley</au><au>Hanson, Robert L.</au><au>Pettitt, David J.</au><au>Nelson, Robert G.</au><au>Puente, Antonio Del</au><au>Mccance, David R.</au><au>Charles, Marie‐Aline</au><au>Bennett, Peter H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rheumatoid arthritis and mortality. A longitudinal study in pima indians</atitle><jtitle>Arthritis and rheumatism</jtitle><addtitle>Arthritis Rheum</addtitle><date>1993-08-01</date><risdate>1993</risdate><volume>36</volume><issue>8</issue><spage>1045</spage><epage>1053</epage><pages>1045-1053</pages><issn>0004-3591</issn><eissn>1529-0131</eissn><coden>ARHEAW</coden><abstract>Objective. To determine the effect of rheumatoid arthritis (RA) on mortality rates. Methods. Longitudinal analyses of data from a cohort of Pima Indians from the Gila River Indian Community in Arizona, who were followed up during the period February 1965 through December 1989. Results. Among 2,979 study subjects aged ≤25 years, there were 858 deaths, 79 of which occurred in subjects with RA (36 men, 43 women). Age and sex‐adjusted mortality rates were slightly higher in subjects with RA than in those without (mortality rate ratio 1.28, 95% confidence interval [95% CI] 1.01–1.62). Among those with RA, mortality rates were higher in older subjects (mortality rate ratio 1.51 per 10‐year increase in age, 95% CI 1.22–1.88), in male subjects (mortality rate ratio 2.23, 95% CI 1.44–3.45, adjusted for age), and in subjects with proteinuria (mortality rate ratio 1.88, 95% CI 1.02–3.46, adjusted for age and sex). Mortality rate ratios for these risk factors were similar in subjects without RA. In addition, among subjects with RA, rheumatoid factor (RF) positivity was predictive of death (mortality rate ratio 1.94, 95% CI 1.10–3.43), and the excess mortality was found primarily among subjects who were seropositive. The death rate from cardiovascular disease (mortality rate ratio 1.77, 95% CI 1.10–2.84) and from liver cirrhosis or other alcohol‐related disease (mortality rate ratio 2.52, 95% CI 1.06–6.01) was increased in persons with RA. Conclusion. The results of this population‐based study suggest that although the risk of mortality in subjects with RA is significantly higher than in those without RA, the risk ratio is in the lower range of that described previously in studies of clinic‐based cohorts. RF positivity as a predictor of early death among subjects with RA indicates that the immunologic processes in seropositive RA may contribute to the events that eventually lead to early death.</abstract><cop>New York</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>8343181</pmid><doi>10.1002/art.1780360804</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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ispartof Arthritis and rheumatism, 1993-08, Vol.36 (8), p.1045-1053
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source Wiley-Blackwell Journals; MEDLINE; Alma/SFX Local Collection
subjects Adult
Age Factors
Aged
Arizona - epidemiology
Arthritis, Rheumatoid - blood
Arthritis, Rheumatoid - epidemiology
Arthritis, Rheumatoid - mortality
Arthritis, Rheumatoid - urine
Biological and medical sciences
Diseases of the osteoarticular system
Female
Humans
Indians, North American
Inflammatory joint diseases
Longitudinal Studies
Male
Medical sciences
Middle Aged
Proteinuria - epidemiology
Rheumatoid Factor - blood
Risk Factors
Sex Factors
Tropical medicine
title Rheumatoid arthritis and mortality. A longitudinal study in pima indians
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