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Trends in rheumatoid arthritis associated cardiovascular mortality in the United States from 1999 to 2020
Muhammad Ahmad1, Dawood Shehzad2, Mustafa Shehzad3
1Department of Medicine, Khyber Medical College, Peshawar, Pakistan.
Insights
Rheumatoid arthritis (RA) increases cardiovascular disease (CVD) mortality risk. Despite an overall decline, significant disparities persist among sexes, races, and geographic regions, necessitating targeted interventions for RA patients.
Area of Science:
- Cardiovascular Health
- Rheumatology
- Public Health Epidemiology
Background:
- Rheumatoid arthritis (RA) is a known risk factor for cardiovascular diseases (CVD).
- Limited data exists on the trends and magnitude of CVD-related mortality in RA patients within the U.S.
- Understanding these trends is crucial for public health initiatives.
Purpose of the Study:
- To analyze the trends and patterns of cardiovascular disease (CVD) mortality among individuals with rheumatoid arthritis (RA) in the United States.
- To identify disparities in RA-associated CVD mortality based on sex, race, and geographic location.
Main Methods:
- Retrospective analysis of the CDC WONDER database (1999-2020).
- Calculated age-adjusted mortality rates (AAMR) and annual percentage change (APC) using Joinpoint regression.
- Stratified outcomes by temporal, sex, racial, and geographic factors.
Main Results:
- Over 128,000 CVD deaths in RA patients (aged 25+) recorded between 1999-2020.
- Overall AAMR decreased from 3.50 to 2.79, but significant sex, racial, and geographic disparities were observed.
- Females, Non-Hispanic American Indian/Alaska Natives, and residents of the Midwest and nonmetropolitan areas faced higher mortality rates.
Conclusions:
- RA-associated CVD mortality shows an upward trend with significant disparities.
- Interventions must address sex, race, and geographic inequalities.
- Targeted, population-level strategies are essential to reduce RA-related CVD mortality.
Introduction:
Rheumatoid Arthritis (RA) is a risk enhancing factor for cardiovascular diseases (CVD). However, data regarding the magnitude and trends of RA associated CVD-related mortality in the United States (U.S) remains scarce.
Methods:
A retrospective analysis was conducted using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) dataset. We extracted age-adjusted mortality rates (AAMR) per 100,000 persons and calculated the annual percentage change (APC) through Joinpoint regression. The outcomes were stratified to discern temporal, sex-based, racial, and geographic patterns in RA-associated CVD mortality.
Results:
Between 1999 and 2020, 128,058 deaths related to CVD in RA patients aged 25 and above were recorded. The AAMR decreased from 3.50 in 1999 to 2.79 in 2020. However, sex disparities persisted, with females consistently experiencing a higher AAMR (3.35) compared to males (1.74). Non-Hispanic (NH) American Indian/Alaska Native had the highest AAMR (4.44) followed by NH White (2.83), NH Black or African American (2.47) and Hispanic or Latino (2.13), while NH Asian/Pacific Islander had the lowest AAMR (1.28). Geographically, the Midwestern region had the highest AAMR (3.12), while the Northeast had the lowest (2.19) with micropolitan (3.47) and nonmetropolitan (3.37) areas exhibiting higher AAMRs compared to large metropolitans (2.28). Notably, states with the highest AAMRs included North Dakota, South Dakota, Vermont, Minnesota and Wyoming.
Conclusion:
Recent trends reveal an upward incline in RA-associated CVD-related mortality with profound disparities related to sex, race, geography and regions. Redressing these disparities necessitates the implementation of targeted population level interventions.
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