title: How many life years are lost in patients with rheumatoid arthritis? Secular cause-specific and all-cause mortality in rheumatoid arthritis, and their predictors in a long-term Australian cohort study.
abstract: BACKGROUND
  There is an excess of mortality in patients with rheumatoid arthritis (RA) but no long-term Australian cohort data.
  
  
  OBJECTIVE
  To determine median life years lost, all-cause standardised mortality ratio (SMR) and cause-specific SMR, their predictors and secular change in Australian patients with RA.
  
  
  METHODS
  Study population was all patients seen by a rheumatologist between 1990 and 1994. Record linkage with Australian National Death Index was performed to determine fact and cause of death up to 2004. All-cause and cause-specific SMR, and median life years lost were determined.
  
  
  RESULTS
  There were 35 (31%) deaths in the early 1990s cohort (n = 113), SMR 1.31 (95% 0.93, 1.80). There were 216 (44%) deaths in the pre-1990s established cohort (n = 495), SMR 1.73 (1.49, 1.95). Median life years lost in the early cohort was 6 years for males and 7 years for females compared with 8 and 10 years, respectively, in the established cohort. Patients with low disease activity score at baseline (DAS < 3.2), SMR was 0.8 (0.3, 2.2) and 1.5 (1.1, 2.2) for the early and established cohorts, and if DAS ≥3.2, SMR was 1.4 (1.02, 1.98) and 1.8 (1.5, 2.1) respectively. Primary cause of death was cardiovascular disease (SMR 1.43 (1.17, 1.74). Patients at most risk were those age 45-54 years. RA was listed as a comorbid condition on the death certificate in only 16% of patients.
  
  
  CONCLUSIONS
  Within a period of 14 years, median life expectancy of patients with RA with disease onset in the early 1990s is reduced by 6-7 years. However, our results also suggest a secular reduction in excess mortality.
authors.affiliation: Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia. marissa.lassere@sesiahs.health.nsw.gov.au
authors.forename: M N
authors.initials: MN
authors.lastname: Lassere
authors.forename: J
authors.initials: J
authors.lastname: Rappo
authors.forename: I J
authors.initials: IJ
authors.lastname: Portek
authors.forename: A
authors.initials: A
authors.lastname: Sturgess
authors.forename: J P
authors.initials: JP
authors.lastname: Edmonds
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000401:mortality*; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000401:mortality; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents