Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2002 Nov;61(11):994–999. doi: 10.1136/ard.61.11.994

Mortality risk associated with rheumatoid arthritis in a prospective cohort of older women: results from the Iowa Women's Health Study

T Mikuls 1, K Saag 1, L Criswell 1, L Merlino 1, R Kaslow 1, B Shelton 1, J Cerhan 1
PMCID: PMC1753931  PMID: 12379522

Abstract

Objective: To determine whether rheumatoid arthritis (RA) is associated with excess mortality among older women.

Methods: RA associated mortality was examined in a prospective cohort study that was started in 1986, and included 31 336 women aged 55–69 years without a history of RA at baseline. Up to 1997, 158 cases of RA were identified and validated against medical records. The relative risk (RR) and 95% confidence interval (CI) were calculated as measures of association between RA onset and subsequent mortality (overall and cause-specific) using Cox proportional hazards regression.

Results: Compared with non-cases, women developing RA during follow up had a significantly increased mortality risk (RR=1.52; 95% CI 1.05 to 2.20). Mortality was higher among rheumatoid factor (RF) positive cases (RR=1.90; 95% CI 1.24 to 2.92) than among RF negative cases (RR=1.00; 95% CI 0.45 to 1.99). There were trends towards increased proportions of RA related deaths from infection (RR=3.61; 95% CI 0.89–14.69) and circulatory disease (RR=1.46; 95% CI 0.76 to 2.81) but not malignancy (RR=0.97; 95% CI 0.46 to 2.04).

Conclusions: RA was associated with significantly increased mortality in a cohort of older women, and the association appeared to be restricted to those with RF positive disease.

Full Text

The Full Text of this article is available as a PDF (143.9 KB).

Figure 1 .

Figure 1

Open in a new tab

Validation process for potential incident cases of rheumatoid arthritis in the Iowa Women's Health Study, 1986–97.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  2. Cerhan James R., Saag Kenneth G., Criswell Lindsey A., Merlino Linda A., Mikuls Ted R. Blood transfusion, alcohol use, and anthropometric risk factors for rheumatoid arthritis in older women. J Rheumatol. 2002 Feb;29(2):246–254. [PubMed] [Google Scholar]
  3. Chehata J. C., Hassell A. B., Clarke S. A., Mattey D. L., Jones M. A., Jones P. W., Dawes P. T. Mortality in rheumatoid arthritis: relationship to single and composite measures of disease activity. Rheumatology (Oxford) 2001 Apr;40(4):447–452. doi: 10.1093/rheumatology/40.4.447. [DOI] [PubMed] [Google Scholar]
  4. Coady S. A., Sorlie P. D., Cooper L. S., Folsom A. R., Rosamond W. D., Conwill D. E. Validation of death certificate diagnosis for coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. J Clin Epidemiol. 2001 Jan;54(1):40–50. doi: 10.1016/s0895-4356(00)00272-9. [DOI] [PubMed] [Google Scholar]
  5. Criswell Lindsey A., Merlino Linda A., Cerhan James R., Mikuls Ted R., Mudano Amy S., Burma Molly, Folsom Aaron R., Saag Kenneth G. Cigarette smoking and the risk of rheumatoid arthritis among postmenopausal women: results from the Iowa Women's Health Study. Am J Med. 2002 Apr 15;112(6):465–471. doi: 10.1016/s0002-9343(02)01051-3. [DOI] [PubMed] [Google Scholar]
  6. Deal C. L., Meenan R. F., Goldenberg D. L., Anderson J. J., Sack B., Pastan R. S., Cohen A. S. The clinical features of elderly-onset rheumatoid arthritis. A comparison with younger-onset disease of similar duration. Arthritis Rheum. 1985 Sep;28(9):987–994. doi: 10.1002/art.1780280905. [DOI] [PubMed] [Google Scholar]
  7. Ferraccioli G. F., Cavalieri F., Mercadanti M., Conti G., Viviano P., Ambanelli U. Clinical features, scintiscan characteristics and X-ray progression of late onset rheumatoid arthritis. Clin Exp Rheumatol. 1984 Apr-Jun;2(2):157–161. [PubMed] [Google Scholar]
  8. Folsom A. R., Kaye S. A., Prineas R. J., Potter J. D., Gapstur S. M., Wallace R. B. Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol. 1990 May;131(5):794–803. doi: 10.1093/oxfordjournals.aje.a115570. [DOI] [PubMed] [Google Scholar]
  9. Folsom A. R., Kushi L. H., Anderson K. E., Mink P. J., Olson J. E., Hong C. P., Sellers T. A., Lazovich D., Prineas R. J. Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med. 2000 Jul 24;160(14):2117–2128. doi: 10.1001/archinte.160.14.2117. [DOI] [PubMed] [Google Scholar]
  10. Folsom A. R., McKenzie D. R., Bisgard K. M., Kushi L. H., Sellers T. A. No association between caffeine intake and postmenopausal breast cancer incidence in the Iowa Women's Health Study. Am J Epidemiol. 1993 Sep 15;138(6):380–383. doi: 10.1093/oxfordjournals.aje.a116870. [DOI] [PubMed] [Google Scholar]
  11. Folsom A. R., Mink P. J., Sellers T. A., Hong C. P., Zheng W., Potter J. D. Hormonal replacement therapy and morbidity and mortality in a prospective study of postmenopausal women. Am J Public Health. 1995 Aug;85(8 Pt 1):1128–1132. doi: 10.2105/ajph.85.8_pt_1.1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gabriel S. E., Crowson C. S., O'Fallon W. M. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955-1985. Arthritis Rheum. 1999 Mar;42(3):415–420. doi: 10.1002/1529-0131(199904)42:3<415::AID-ANR4>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  13. Goraya T. Y., Jacobsen S. J., Belau P. G., Weston S. A., Kottke T. E., Roger V. L. Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota. Mayo Clin Proc. 2000 Jul;75(7):681–687. doi: 10.4065/75.7.681. [DOI] [PubMed] [Google Scholar]
  14. Healey L. A., Sheets P. K. The relation of polymyalgia rheumatica to rheumatoid arthritis. J Rheumatol. 1988;15(5):750–752. [PubMed] [Google Scholar]
  15. Hernandez-Avila M., Liang M. H., Willett W. C., Stampfer M. J., Colditz G. A., Rosner B., Chang R. W., Hennekens C. H., Speizer F. E. Exogenous sex hormones and the risk of rheumatoid arthritis. Arthritis Rheum. 1990 Jul;33(7):947–953. doi: 10.1002/art.1780330705. [DOI] [PubMed] [Google Scholar]
  16. Korn E. L., Graubard B. I., Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997 Jan 1;145(1):72–80. doi: 10.1093/oxfordjournals.aje.a009034. [DOI] [PubMed] [Google Scholar]
  17. Kroot E. J., van Leeuwen M. A., van Rijswijk M. H., Prevoo M. L., Van 't Hof M. A., van De Putte L. B., van Riel P. L. No increased mortality in patients with rheumatoid arthritis: up to 10 years of follow up from disease onset. Ann Rheum Dis. 2000 Dec;59(12):954–958. doi: 10.1136/ard.59.12.954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lindqvist E., Eberhardt K. Mortality in rheumatoid arthritis patients with disease onset in the 1980s. Ann Rheum Dis. 1999 Jan;58(1):11–14. doi: 10.1136/ard.58.1.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lloyd-Jones D. M., Martin D. O., Larson M. G., Levy D. Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med. 1998 Dec 15;129(12):1020–1026. doi: 10.7326/0003-4819-129-12-199812150-00005. [DOI] [PubMed] [Google Scholar]
  20. MacGregor A. J., Bamber S., Silman A. J. A comparison of the performance of different methods of disease classification for rheumatoid arthritis. Results of an analysis from a nationwide twin study. J Rheumatol. 1994 Aug;21(8):1420–1426. [PubMed] [Google Scholar]
  21. MacGregor A. J., Silman A. J. A reappraisal of the measurement of disease occurrence in rheumatoid arthritis. J Rheumatol. 1992 Aug;19(8):1163–1165. [PubMed] [Google Scholar]
  22. Mikuls T. R., Saag K. G. Comorbidity in rheumatoid arthritis. Rheum Dis Clin North Am. 2001 May;27(2):283–303. doi: 10.1016/s0889-857x(05)70202-7. [DOI] [PubMed] [Google Scholar]
  23. Mikuls Ted R., Cerhan James R., Criswell Lindsey A., Merlino Linda, Mudano Amy S., Burma Molly, Folsom Aaron R., Saag Kenneth G. Coffee, tea, and caffeine consumption and risk of rheumatoid arthritis: results from the Iowa Women's Health Study. Arthritis Rheum. 2002 Jan;46(1):83–91. doi: 10.1002/1529-0131(200201)46:1<83::AID-ART10042>3.0.CO;2-D. [DOI] [PubMed] [Google Scholar]
  24. Mitchell D. M., Spitz P. W., Young D. Y., Bloch D. A., McShane D. J., Fries J. F. Survival, prognosis, and causes of death in rheumatoid arthritis. Arthritis Rheum. 1986 Jun;29(6):706–714. doi: 10.1002/art.1780290602. [DOI] [PubMed] [Google Scholar]
  25. Moyer L. A., Boyle C. A., Pollock D. A. Validity of death certificates for injury-related causes of death. Am J Epidemiol. 1989 Nov;130(5):1024–1032. doi: 10.1093/oxfordjournals.aje.a115403. [DOI] [PubMed] [Google Scholar]
  26. Pincus T., Brooks R. H., Callahan L. F. Prediction of long-term mortality in patients with rheumatoid arthritis according to simple questionnaire and joint count measures. Ann Intern Med. 1994 Jan 1;120(1):26–34. doi: 10.7326/0003-4819-120-1-199401010-00005. [DOI] [PubMed] [Google Scholar]
  27. Schaufelberger C., Bengtsson B. A., Andersson R. Epidemiology and mortality in 220 patients with polymyalgia rheumatica. Br J Rheumatol. 1995 Mar;34(3):261–264. doi: 10.1093/rheumatology/34.3.261. [DOI] [PubMed] [Google Scholar]
  28. Silman A. J., Newman J., MacGregor A. J. Cigarette smoking increases the risk of rheumatoid arthritis. Results from a nationwide study of disease-discordant twins. Arthritis Rheum. 1996 May;39(5):732–735. doi: 10.1002/art.1780390504. [DOI] [PubMed] [Google Scholar]
  29. Symmons D. P., Bankhead C. R., Harrison B. J., Brennan P., Barrett E. M., Scott D. G., Silman A. J. Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis: results from a primary care-based incident case-control study in Norfolk, England. Arthritis Rheum. 1997 Nov;40(11):1955–1961. doi: 10.1002/art.1780401106. [DOI] [PubMed] [Google Scholar]
  30. Symmons D. P., Barrett E. M., Bankhead C. R., Scott D. G., Silman A. J. The incidence of rheumatoid arthritis in the United Kingdom: results from the Norfolk Arthritis Register. Br J Rheumatol. 1994 Aug;33(8):735–739. doi: 10.1093/rheumatology/33.8.735. [DOI] [PubMed] [Google Scholar]
  31. Symmons D. P., Jones M. A., Scott D. L., Prior P. Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well. J Rheumatol. 1998 Jun;25(6):1072–1077. [PubMed] [Google Scholar]
  32. Terkeltaub R., Esdaile J., Décary F., Tannenbaum H. A clinical study of older age rheumatoid arthritis with comparison to a younger onset group. J Rheumatol. 1983 Jun;10(3):418–424. [PubMed] [Google Scholar]
  33. Uhlig T., Hagen K. B., Kvien T. K. Current tobacco smoking, formal education, and the risk of rheumatoid arthritis. J Rheumatol. 1999 Jan;26(1):47–54. [PubMed] [Google Scholar]
  34. Voigt L. F., Koepsell T. D., Nelson J. L., Dugowson C. E., Daling J. R. Smoking, obesity, alcohol consumption, and the risk of rheumatoid arthritis. Epidemiology. 1994 Sep;5(5):525–532. [PubMed] [Google Scholar]
  35. Ward M. M. Recent improvements in survival in patients with rheumatoid arthritis: better outcomes or different study designs? Arthritis Rheum. 2001 Jun;44(6):1467–1469. doi: 10.1002/1529-0131(200106)44:6<1467::AID-ART243>3.0.CO;2-6. [DOI] [PubMed] [Google Scholar]
  36. Wolfe F., Mitchell D. M., Sibley J. T., Fries J. F., Bloch D. A., Williams C. A., Spitz P. W., Haga M., Kleinheksel S. M., Cathey M. A. The mortality of rheumatoid arthritis. Arthritis Rheum. 1994 Apr;37(4):481–494. doi: 10.1002/art.1780370408. [DOI] [PubMed] [Google Scholar]
  37. Yazici Y., Paget S. A. Elderly-onset rheumatoid arthritis. Rheum Dis Clin North Am. 2000 Aug;26(3):517–526. doi: 10.1016/s0889-857x(05)70154-x. [DOI] [PubMed] [Google Scholar]
  38. van Schaardenburg D., Hazes J. M., de Boer A., Zwinderman A. H., Meijers K. A., Breedveld F. C. Outcome of rheumatoid arthritis in relation to age and rheumatoid factor at diagnosis. J Rheumatol. 1993 Jan;20(1):45–52. [PubMed] [Google Scholar]
  39. van der Heijde D. M., van Riel P. L., van Leeuwen M. A., van 't Hof M. A., van Rijswijk M. H., van de Putte L. B. Older versus younger onset rheumatoid arthritis: results at onset and after 2 years of a prospective followup study of early rheumatoid arthritis. J Rheumatol. 1991 Sep;18(9):1285–1289. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES