title: Improved survival in rheumatoid arthritis: a general population-based cohort study.
abstract: OBJECTIVE
  Mortality trends of rheumatoid arthritis (RA) are largely unknown over the past decade when new drugs and management strategies have been adopted to effectively treat RA.
  
  
  METHODS
  Using The Health Improvement Network, an electronic medical record database representative of the UK general population, we identified patients with incident RA and up to five individuals without RA matched for age, sex and year of diagnosis between 1999 and 2014. The RA cohort was divided in two sub-cohorts based on the year of RA diagnosis: the early cohort (1999-2006) and the late cohort (2007-2014). We compared mortality rates, HRs (using a Cox proportional hazard model) and rate differences (using an additive hazard model) between RA and non-RA cohorts adjusting for potential confounders.
  
  
  RESULTS
  Patients with RA diagnosed between 1999 and 2006 had a considerably higher mortality rate than their comparison cohort (ie, 29.1 vs 18.0 deaths/1000 person-years), as compared with a moderate difference in patients with RA diagnosed between 2007 and 2014 and their comparison cohort (17.0 vs 12.9 deaths/1000 years). The corresponding absolute mortality rate differences were 9.5 deaths/1000 person-years (95% CIs 7.5 to 11.6) and 3.1 deaths/1000 person-years (95% CI 1.5 to 4.6) and the mortality HRs were 1.56 (95% CI 1.44 to 1.69) and 1.29 (95% CI 1.17 to 1.42), respectively (both p values for interaction <0.01).
  
  
  CONCLUSIONS
  This general population-based cohort study indicates that the survival of patients with RA has improved over the past decade to a greater degree than in the general population. Improved management of RA and its associated comorbidities over recent years may be providing a survival benefit.
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Peloquin
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Dubreuil
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Tuhina
authors.identifier: http://orcid.org/0000-0002-9515-1711
authors.initials: T
authors.lastname: Neogi
authors.affiliation: Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: J Antonio
authors.initials: JA
authors.lastname: Aviña-Zubieta
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sharan K
authors.initials: SK
authors.lastname: Rai
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.|Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada.|Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends*; D006113:United Kingdom / Q000453:epidemiology
keywords: DMARDs (biologic); Epidemiology; Rheumatoid Arthritis