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County-Level Association Between Social Vulnerability and Rheumatoid Arthritis-Related Mortality in the United

Wan-Ying Lin^1,2, Yu-Che Lee³, Abira A Chowdhury^1,2

¹Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY 14260, USA.

Medical Sciences (Basel, Switzerland)

|June 25, 2026

Summary

Social vulnerability impacts rheumatoid arthritis (RA) mortality, with household composition and disability being key risk factors. Understanding these specific social vulnerability domains can improve RA patient care and outcomes.

Keywords:

county-level analysis mortality rheumatoid arthritis social vulnerability index

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Area of Science:

Public Health
Rheumatology
Sociology

Background:

Rheumatoid arthritis (RA) poses a significant mortality risk.
Social vulnerability is increasingly recognized as a determinant of health outcomes.
The Social Vulnerability Index (SVI) provides a framework for assessing community-level social risk factors.

Purpose of the Study:

To examine the relationship between social vulnerability and RA-related mortality in the U.S.
To identify specific domains of the SVI that are most strongly associated with RA mortality.
To inform targeted interventions for high-risk RA patient populations.

Main Methods:

County-level ecological study utilizing U.S. mortality data (2010-2019).
Analysis of age-adjusted RA mortality rates and the CDC SVI.
Gamma regression models to assess associations between RA mortality and overall SVI and its four domains.

Main Results:

Over 350,000 RA deaths occurred between 2010-2019.
Household composition and disability vulnerability showed the strongest positive association with RA mortality.
Minority status/language vulnerability was inversely associated; socioeconomic vulnerability showed mixed results.

Conclusions:

RA mortality risk is linked to specific SVI domains, not just overall vulnerability.
Household composition and disability are critical risk factors for RA mortality.
Domain-specific SVI assessment can improve RA risk stratification and patient management.