Mortality profile of patients with rheumatoid arthritis in France and its change in 10 years

Objective: To study the mortality profile of patients with rheumatoid arthritis (RA) in France. Methods: Data were collected between 2000 and 2011 from the French Epidemiological Center for the Medical Causes of Death database; all death certificates from adults that either mentioned RA as an underlying cause of death (UCD) or as an associated cause of death (ACD) were evaluated using multiple cause-of-death analysis. The different causes of death and their frequency were reported, together with the ratio of observed/expected number of death (O/E ratio) to measure the strength of association between RA listed as an ACD and the corresponding UCD. Results: During the study period, 13,208 deaths related to RA were identified. The mean +/- SD age at death was 79 +/- 9 years (51% with >= 80 years) and the female/male ratio was 3.2. When RA was the UCD (n = 4597), the main causes of death were cardiovascular (29%) and infectious diseases (22%). When RA was an ACD (n = 8611), the most common UCDs were cardiovascular diseases (35%), neoplasms (14%), respiratory disease (9%), and infectious diseases (7%). The overall O/E ratio was > 1 for infectious (3.58), respiratory (1.38), and cardiovascular diseases (1.25), but was < 1 for neoplasms. Conclusion: We provide the most recent national multiple-cause-of-death analysis assessing the mortality profile of RA patients. Our results show that mortality related to cardiovascular, respiratory, and infectious diseases is highly associated with RA. These data support the need to expand new strategies to prevent infectious and cardiovascular diseases in order to improve survival of RA patients. (C) 2017 Elsevier Inc. All rights reserved.