title: Trends in Excess Mortality Among Patients With Rheumatoid Arthritis in Ontario, Canada.
abstract: OBJECTIVE
  To evaluate excess mortality over time, comparing rheumatoid arthritis (RA) patients with the general population.
  
  
  METHODS
  We computed all-cause mortality rates among Ontario residents age ≥15 years with RA versus without RA from 1996 to 2009. Age- and sex-standardized mortality rates were expressed as the number of deaths per 1,000 population. Excess mortality rates were calculated as the difference between death rates among RA patients and those in the general population. We estimated standardized mortality ratios (SMRs) and mortality rate ratios (MRRs) to assess relative excess mortality over time.
  
  
  RESULTS
  From 1996 to 2009, SMRs in RA ranged from 13.0 (95% confidence interval [95% CI] 12.2, 13.9) to 9.2 deaths per 1,000 RA patients (95% CI 8.4, 10.0); and for those without RA from 8.7 (95% CI 8.6, 8.7) to 6.0 deaths (95% CI 5.9, 6.0) per 1,000 general population. Over the study period, the excess mortality rate among RA patients was approximately 3 excess deaths per 1,000 population. Relative reductions in standardized mortality rates occurred over time for those with and without RA (-21.4% versus -13.4%). The SMRs for RA patients in 1996-1997, 2000-2001, 2004-2005, and 2008-2009 were 1.51 (95% CI 1.43, 1.59), 1.50 (95% CI 1.43, 1.57), 1.43 (95% CI 1.37, 1.50), and 1.41 (95% CI 1.35, 1.47), respectively. We did not find a significant change in the MRR by calendar time.
  
  
  CONCLUSIONS
  Mortality for RA patients has decreased over time but remains elevated compared to the general population, with 40-50% more deaths among RA patients. The relative excess mortality over time (mortality gap) remains unchanged in our sample.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, and McGill University, Montreal, Quebec, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Widdifield
authors.affiliation: McGill University, Montreal, Quebec, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, and McMaster University, Hamilton, Ontario, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.affiliation: Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.affiliation: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Bindee
authors.initials: B
authors.lastname: Kuriya
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: J Carter
authors.initials: JC
authors.lastname: Thorne
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Hollands
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017678:Sex Distribution; D055815:Young Adult