Population-level influence of rheumatoid arthritis on mortality and recent trends: a multiple cause-of-death analysis in France, 1970-2002.

OBJECTIVE

We studied the population-level influence of rheumatoid arthritis (RA) on the mortality of the French population and the pattern of associated causes between 1970 and 2002, using death certificates.

METHODS

All French death certificates (n=17,806,923) between 1970 and 2002 were analyzed. Mortality rates related to RA were studied using Poisson regression, and associated causes of death were estimated using the method of observed/expected pairs. Modifications of the International Classification of Diseases and coding methods were considered.

RESULTS

RA was mentioned in 0.22% of death certificates. The age-adjusted mortality rates declined during the initial period, but increased in the early 1990s, this trend being driven by the rise in mortality in older groups. The mean age at death was lower for RA-associated deaths than for the general population. Patterns of associated causes of death were identified: there was an increase of the associations with injury, poisoning, external causes, and immunosuppressive toxicities; and a decrease of the associations with endocrine diseases, decubitus ulcers, and glucocorticoid toxicities.

CONCLUSION

RA has a significant impact on mortality in the French population, with a trend toward an increase of associated mortality rates in the older population groups starting in the 1990s.