title: Improvement in 5-year mortality in incident rheumatoid arthritis compared with the general population-closing the mortality gap.
abstract: OBJECTIVE
  Excess mortality in rheumatoid arthritis (RA) is expected to have improved over time, due to improved treatment. Our objective was to evaluate secular 5-year mortality trends in RA relative to general population controls in incident RA cohorts diagnosed in 1996-2000 vs 2001-2006.
  
  
  METHODS
  We conducted a population-based cohort study, using administrative health data, of all incident RA cases in British Columbia who first met RA criteria between January 1996 and December 2006, with general population controls matched 1:1 on gender, birth and index years. Cohorts were divided into earlier (RA onset 1996-2000) and later (2001-2006) cohorts. Physician visits and vital statistics data were obtained until December 2010. Follow-up was censored at 5 years to ensure equal follow-up in both cohorts. Mortality rates, mortality rate ratios and HRs for mortality (RA vs controls) using proportional hazard models adjusting for age, were calculated. Differences in mortality in RA versus controls between earlier and later incident cohorts were tested via interaction between RA status (case/control) and cohort (earlier/later).
  
  
  RESULTS
  24 914 RA cases and controls experienced 2747 and 2332 deaths, respectively. Mortality risk in RA versus controls differed across incident cohorts for all-cause, cardiovascular diseases (CVD) and cancer mortality (interactions p<0.01). A significant increase in mortality in RA versus controls was observed in earlier, but not later, cohorts (all-cause mortality adjusted HR (95% CI): 1.40 (1.30 to 1.51) and 0.97 (0.89 to 1.05), respectively).
  
  
  CONCLUSIONS
  In our population-based incident RA cohort, mortality compared with the general population improved over time. Increased mortality in the first 5 years was observed in people with RA onset before, but not after, 2000.
authors.affiliation: Arthritis Research Canada, Richmond, British Columbia, Canada.|Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Lacaille
authors.affiliation: Arthritis Research Canada, Richmond, British Columbia, Canada.|Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: J Antonio
authors.initials: JA
authors.lastname: Avina-Zubieta
authors.affiliation: Arthritis Research Canada, Richmond, British Columbia, Canada.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Sayre
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000401:mortality*; D001955:British Columbia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D002423:Cause of Death; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*
keywords: Epidemiology; Outcomes research; Rheumatoid Arthritis