Jacobsson L T, Knowler W C, Pillemer S, Hanson R L, Pettitt D J, Nelson R G, del Puente A, McCance D R, Charles M A, Bennett P H
National Institute of Arthritis and Musculoskeletal and Skin Diseases, Phoenix, Arizona.
Arthritis Rheum. 1993 Aug;36(8):1045-53. doi: 10.1002/art.1780360804.
To determine the effect of rheumatoid arthritis (RA) on mortality rates.
Longitudinal analyses of data from a cohort of Pima Indians from the Gila River Indian Community in Arizona, who were followed up during the period February 1965 through December 1989.
Among 2,979 study subjects aged > or = 25 years, there were 858 deaths, 79 of which occurred in subjects with RA (36 men, 43 women). Age- and sex-adjusted mortality rates were slightly higher in subjects with RA than in those without (mortality rate ratio 1.28, 95% confidence interval [95% CI] 1.01-1.62). Among those with RA, mortality rates were higher in older subjects (mortality rate ratio 1.51 per 10-year increase in age, 95% CI 1.22-1.88), in male subjects (mortality rate ratio 2.23, 95% CI 1.44-3.45, adjusted for age), and in subjects with proteinuria (mortality rate ratio 1.88, 95% CI 1.02-3.46, adjusted for age and sex). Mortality rate ratios for these risk factors were similar in subjects without RA. In addition, among subjects with RA, rheumatoid factor (RF) positivity was predictive of death (mortality rate ratio 1.94, 95% CI 1.10-3.43), and the excess mortality was found primarily among subjects who were seropositive. The death rate from cardiovascular disease (mortality rate ratio 1.77, 95% CI 1.10-2.84) and from liver cirrhosis or other alcohol-related disease (mortality rate ratio 2.52, 95% CI 1.06-6.01) was increased in persons with RA.
The results of this population-based study suggest that although the risk of mortality in subjects with RA is significantly higher than in those without RA, the risk ratio is in the lower range of that described previously in studies of clinic-based cohorts. RF positivity as a predictor of early death among subjects with RA indicates that the immunologic processes in seropositive RA may contribute to the events that eventually lead to early death.
确定类风湿关节炎（RA）对死亡率的影响。
对来自亚利桑那州吉拉河印第安社区的皮马印第安人队列数据进行纵向分析，这些人在1965年2月至1989年12月期间接受随访。
在2979名年龄≥25岁的研究对象中，有858人死亡，其中79人发生在RA患者中（36名男性，43名女性）。RA患者的年龄和性别调整死亡率略高于非RA患者（死亡率比1.28，95%置信区间[95%CI]1.01 - 1.62）。在RA患者中，老年患者的死亡率更高（每增加10岁死亡率比1.51，95%CI 1.22 - 1.88），男性患者更高（死亡率比2.23，95%CI 1.44 - 3.45，年龄调整后），蛋白尿患者也更高（死亡率比1.88，95%CI 1.02 - 3.46，年龄和性别调整后）。这些危险因素的死亡率比在非RA患者中相似。此外，在RA患者中，类风湿因子（RF）阳性可预测死亡（死亡率比1.94，95%CI 1.10 - 3.43），且额外死亡率主要见于血清阳性患者。RA患者的心血管疾病死亡率（死亡率比1.77，95%CI 1.10 - 2.84）和肝硬化或其他酒精相关疾病死亡率（死亡率比2.52，95%CI 1.06 - 6.01）有所增加。
这项基于人群的研究结果表明，虽然RA患者的死亡风险显著高于非RA患者，但风险比处于先前基于临床队列研究中所描述范围的较低水平。RF阳性作为RA患者早期死亡的预测指标表明，血清阳性RA中的免疫过程可能促成最终导致早期死亡的事件。
