title: Influence of demographic and clinical factors on the mortality rate of a rheumatoid arthritis cohort: A 20-year survival study.
abstract: OBJECTIVE
  To describe the mortality rate (MR) and standardized MR (SMR) of an incident cohort of rheumatoid arthritis (RA) patients followed up for 20 years, and to analyze the influence on morality risk of different demographic and clinical variables, including radiographic joint damage.
  
  
  METHODS
  Retrospective longitudinal study that included 2271 RA patients attending the rheumatology outpatient clinic of the Hospital Clínico San Carlos (Madrid, Spain), enrolled from January 1994 to February 2013 and followed up from RA diagnosis to patients׳ death or September 2013. Disability and disease activity were measured as the averaged value of the Heath Assessment Questionnaire and the erythrocyte sedimentation rate, respectively, of the first 2 years after RA diagnosis. Radiographic joint damage of hands and wrists was assessed with the Sharp/van der Heijde score. Indirect SMRs with a 95% of confidence interval (95% CI) were calculated. Cox bivariate and multivariate regression models were performed to assess risk factors for death.
  
  
  RESULTS
  A total of 431 patients died (19%) during the observation time (18,482 person-years), resulting in a MR of 23 subjects per 1000 patient-years [95% CI: 21-26]. SMR was 1.89 (1.72-2.08). In the multivariate analysis, men, older age at diagnosis, the presence of rheumatoid factor, higher number of hospital admissions, greater disease activity, and greater radiographic joint damage were independently associated with greater mortality risk.
  
  
  CONCLUSIONS
  RA patients have an excess mortality compared with the general population. Radiological joint damage and early disease activity are independent mortality risk factors. A tighter control at early stages may be necessary to reduce mortality.
authors.affiliation: Rheumatology Department and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Calle Prof. MArtín Lagos s/n, Madrid 28040, Spain. Electronic address: lydia.abasolo@salud.madrid.org.
authors.forename: Lydia
authors.initials: L
authors.lastname: Abasolo
authors.affiliation: Rheumatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Ivorra-Cortes
authors.affiliation: Rheumatology Department and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Calle Prof. MArtín Lagos s/n, Madrid 28040, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Leon
authors.affiliation: Rheumatology Department and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Calle Prof. MArtín Lagos s/n, Madrid 28040, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Jover
authors.affiliation: Rheumatology Department and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Calle Prof. MArtín Lagos s/n, Madrid 28040, Spain.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fernandez-Gutierrez
authors.affiliation: Rheumatology Department and Health Research Institute (IDISSC), Hospital Clínico San Carlos, Calle Prof. MArtín Lagos s/n, Madrid 28040, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Rodriguez-Rodriguez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate
keywords: Mortality; Radiographic joint damage; Rheumatoid arthritis; Survival analysis