Health and Demographic Impact on COVID-19 Infection and Mortality in US Counties

AbstractIntroductionWith the pandemic of COVID-19, the number of confirmed cases and related deaths are increasing in the US. We aimed to understand the potential impact of health and demographic factors on the infection and mortality rates of COVID-19 at the population level.MethodsWe collected total number of confirmed cases and deaths related to COVID-19 at the county level in the US from January 21, 2020 to April 23, 2020. We extracted health and demographic measures for each US county. Multivariable linear mixed effects models were used to investigate potential correlations of health and demographic characteristics with the infection and mortality rates of COVID-19 in US counties.ResultsOur models showed that several health and demographic factors were positively correlated with the infection rate of COVID-19, such as low education level and percentage of Black. In contrast, several factors, including percentage of smokers and percentage of food insecure, were negatively correlated with the infection rate of COVID-19. While the number of days since first confirmed case and the infection rate of COVID-19 were negatively correlated with the mortality rate of COVID-19, percentage of elders (65 and above) and percentage of rural were positively correlated with the mortality rate of COVID-19.ConclusionsAt the population level, health and demographic factors could impact the infection and mortality rates of COVID-19 in US counties.

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Racism as a Leading Cause of Death: Measuring Excess Deaths in the US

10.1101/2021.08.30.21262732 ◽

2021 ◽

Author(s):

Daisy Massey ◽

Jeremy Faust ◽

Karen Dorsey ◽

Yuan Lu ◽

Harlan Krumholz

Keyword(s):

Black Women ◽

Mortality Rate ◽

Black Men ◽

Cause Of Death ◽

White Women ◽

Black People ◽

Mortality Rates ◽

White People ◽

The Us ◽

Excess Deaths

Background: Excess death for Black people compared with White people is a measure of health equity. We sought to determine the excess deaths under the age of 65 (<65) for Black people in the United States (US) over the most recent 20-year period. We also compared the excess deaths for Black people with a cause of death that is traditionally reported. Methods: We used the Multiple Cause of Death 1999-2019 dataset from the Center of Disease Control (CDC) WONDER to report age-adjusted mortality rates among non-Hispanic Black (Black) and non-Hispanic White (White) people and to calculate annual age-adjusted <65 excess deaths for Black people from 1999-2019. We measured the difference in mortality rates between Black and White people and the 20-year and 5-year trends using linear regression. We compared age-adjusted <65 excess deaths for Black people to the primary causes of death among <65 Black people in the US. Results: From 1999 to 2019, the age-adjusted mortality rate for Black men was 1,186 per 100,000 and for White men was 921 per 100,000, for a difference of 265 per 100,000. The age-adjusted mortality rate for Black women was 802 per 100,000 and for White women was 664 per 100,000, for a difference of 138 per 100,000. While the gap for men and women is less than it was in 1999, it has been increasing among men since 2014. These differences have led to many Black people dying before age 65. In 1999, there were 22,945 age-adjusted excess deaths among Black women <65 and in 2019 there were 14,444, deaths that would not have occurred had their risks been the same as those of White women. Among Black men, 38,882 age-adjusted excess <65 deaths occurred in 1999 and 25,850 in 2019. When compared to the top 5 causes of deaths among <65 Black people, death related to disparities would be the highest mortality rate among both <65 Black men and women. Comment: In the US, over the recent 20-year period, disparities in mortality rates resulted in between 61,827 excess deaths in 1999 and 40,294 excess deaths in 2019 among <65 Black people. The race-based disparity in the US was the leading cause of death among <65 Black people. Societal commitment and investment in eliminating disparities should be on par with those focused on other leading causes of death such as heart disease and cancer.

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The Infection Rate of COVID-19 in Wuhan, China: Combined Analysis of Population Samples (Preprint)

10.2196/preprints.20914 ◽

2020 ◽

Author(s):

Hui-Qi Qu ◽

Zhangkai Jason Cheng ◽

Zhifeng Duan ◽

Lifeng Tian ◽

Hakon Hakonarson

Keyword(s):

Mortality Rate ◽

Infection Rate ◽

Case Fatality ◽

Mortality Rates ◽

Accurate Estimate ◽

Combined Analysis ◽

Infected People ◽

Health Measures ◽

Asymptomatic Infections ◽

Combined Infection

BACKGROUND The coronavirus disease (COVID-19) pandemic began in Wuhan, China, in December 2019. Wuhan had a much higher mortality rate than the rest of China. However, a large number of asymptomatic infections in Wuhan may have never been diagnosed, contributing to an overestimated mortality rate. OBJECTIVE This study aims to obtain an accurate estimate of infections in Wuhan using internet data. METHODS In this study, we performed a combined analysis of the infection rate among evacuated foreign citizens to estimate the infection rate in Wuhan in late January and early February. RESULTS Based on our analysis, the combined infection rate of the foreign evacuees was 0.013 (95% CI 0.008-0.022). Therefore, we estimate the number of infected people in Wuhan to be 143,000 (range 88,000-242,000), which is significantly higher than previous estimates. Our study indicates that a large number of infections in Wuhan were not diagnosed, which has resulted in an overestimated case fatality rate. CONCLUSIONS Increased awareness of the original infection rate of Wuhan is critical for proper public health measures at all levels, as well as to eliminate panic caused by overestimated mortality rates that may bias health policy actions by the authorities.

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Extracranial—intracranial bypass in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the United States between 1992 and 2001: a population-based study

Journal of Neurosurgery ◽

10.3171/jns.2005.103.5.0794 ◽

2005 ◽

Vol 103 (5) ◽

pp. 794-804 ◽

Cited By ~ 69

Author(s):

Sepideh Amin-Hanjani ◽

William E. Butler ◽

Christopher S. Ogilvy ◽

Bob S. Carter ◽

Fred G. Barker

Keyword(s):

Mortality Rate ◽

Cerebrovascular Disease ◽

Intracranial Aneurysms ◽

Mortality Rates ◽

Population Based ◽

Annual Number ◽

Content Type ◽

Bypass Procedure ◽

The Us ◽

Fine Print

Object. The authors assessed the results of extracranial—intracranial (EC—IC) bypass surgery in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the US between 1992 and 2001 by using population-based methods. Methods. This is a retrospective cohort study based on data from the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, MD). Five hundred fifty-eight operations were performed at 158 hospitals by 115 identified surgeons. The indications for surgery were cerebral ischemia in 74% of the operations (2.4% mortality rate), unruptured aneurysms in 19% of the operations (7.7% mortality rate), and ruptured aneurysms in 7% of the operations (21% mortality rate). Overall, 4.6% of the patients died and 4.7% of the patients were discharged to long-term facilities, 16.4% to short-term facilities, and 74.2% to their homes. The annual number of admissions in the US increased from 190 per year (1992–1996) to 360 per year (1997–2001), whereas the mortality rates increased from 2.8% (1992–1996) to 5.7% (1997–2001). The median annual number of procedures was three per hospital (range one–27 operations) or two per surgeon (range one–21 operations). For 29% of patients, their bypass procedure was the only one recorded at their particular hospital during that year; for these institutions the mean annual caseload was 0.4 admissions per year. For 42% of patients, their particular surgeon performed no other bypass procedure during that year. Older patient age (p < 0.001) and African-American race (p = 0.005) were risk factors for adverse outcome. In a multivariate analysis in which adjustments were made for age, sex, race, diagnosis, admission type, geographic region, medical comorbidity, and year of surgery, high-volume hospitals less frequently had an adverse discharge disposition (odds ratio 0.54, p = 0.03). Conclusions. Most EC—IC bypasses performed in the US during the last decade were performed for occlusive cerebrovascular disease. Community mortality rates for aneurysm treatment including bypass procedures currently exceed published values from specialized centers and, during the period under study, the mortality rates increased with time for all diagnostic subgroups. This technically demanding procedure has become a very low-volume operation at most US centers.

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RACIAL DISPARITIES IN RURAL-URBAN MORTALITY GAP IN THE UNITED STATES: A 24-YEAR LONGITUDINAL STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.2685 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S733-S733

Author(s):

Nasim Ferdows ◽

Soroosh Baghban Ferdows ◽

Amit Kumar

Keyword(s):

Mortality Rate ◽

Rural Areas ◽

Urban Areas ◽

Fixed Effects ◽

The United States ◽

Mortality Rates ◽

Race And Gender ◽

Racial Gap ◽

The Us ◽

And Gender

Abstract Although overall life expectancy in the US has improved rapidly over the course of the 20th century and the racial gap in all-cause mortality has declined in recent decades, geographical disparities in mortality have increased in the last three decades. This research aims to study racial and geographical disparities by comparing the race and sex-specific mortality trends of the US rural and urban populations. We created a longitudinal county level analytic file of the US population 65 years and older, over the period of 1968 to 2015 obtained from CDC-WONDER and Area Health Resources Files. First, we used an OLS regression of age-adjusted mortality rate onto year indicators interaction with race and gender to depict the race and sex-specific trend in age-adjusted mortality rates. We also estimated the change in in mortality rate over time, for each race and gender, relative to values in 1968. Finally, we estimated race and sex specific trend in rural-urban mortality gap using state fixed effects regression. Our results indicate that racial gap in mortality rates has only declined in urban areas. Mortality rates of the whites in rural areas declined more rapidly than their Black counterparts, resulting in a gap that has been widening in the last three decades. The racial gap has increased considerably for males residing in rural counties not adjacent to an urban county. Thus, racial disparity in mortality has increased in rural areas, with a considerable widening between white and black male population living in the more remote rural areas.

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Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload

Journal of Neurosurgery ◽

10.3171/jns.2005.102.6.0977 ◽

2005 ◽

Vol 102 (6) ◽

pp. 977-986 ◽

Cited By ~ 92

Author(s):

William T. Curry ◽

Michael W. McDermott ◽

Bob S. Carter ◽

Fred G. Barker

Keyword(s):

Mortality Rate ◽

Hospital Discharge ◽

High Volume ◽

Mortality Rates ◽

Content Type ◽

Relative Mortality ◽

Discharge Disposition ◽

The Us ◽

Meningioma Surgery ◽

Fine Print

Object. The goal of this study was to determine the risk of adverse outcomes after contemporary surgical treatment of meningiomas in the US and trends in patient outcomes and patterns of care. Methods. The authors performed a retrospective cohort study by using the Nationwide Inpatient Sample covering the period of 1988 to 2000. Multivariate regression models with disposition end points of death and hospital discharge were used to test patient, surgeon, and hospital characteristics, including volume of care, as outcome predictors. Multivariate analyses revealed that larger-volume centers had lower mortality rates for patients who underwent craniotomy for meningioma (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.59–0.93, p = 0.01). Adverse discharge disposition was also less likely at high-volume hospitals (OR 0.71, 95% CI 0.62–0.80, p < 0.001). With respect to the surgeon caseload, there was a trend toward a lower rate of mortality after surgery when higher-caseload providers were involved, and a significantly less frequent adverse discharge disposition (OR 0.71, 95% CI 0.62–0.80, p <, 0.001). The annual meningioma caseload in the US increased 83% between 1988 and 2000, from 3900 patients/year to 7200 patients/year. In-hospital mortality rates decreased 61%, from 4.5% in 1988 to 1.8% in 2000. Reductions in the mortality rates were largest at high-volume centers (a 72% reduction in the relative mortality rate at largest-volume-quintile centers, compared with a 6% increase in the relative mortality rate at lowest-volume-quintile centers). The number of US hospitals where craniotomies were performed for meningiomas increased slightly. Fewer centers hosted one meningioma resection annually, whereas the largest centers had disproportionate increases in their caseloads, indicating a modest centralization of meningioma surgery in the US during this interval. Conclusions. The mortality and adverse hospital discharge disposition rates were lower when meningioma surgery was performed by high-volume providers. The annual US caseload increased, whereas the mortality rates decreased, especially at high-volume centers.

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Pregnancy Outcomes in Women with Sickle Cell Disease in California: A Retrospective Cohort Study

Blood ◽

10.1182/blood-2021-151715 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 489-489

Author(s):

Samantha C Fisch ◽

Ann M Brunson ◽

Anjlee Mahajan ◽

Theresa Keegan ◽

Bo Yu ◽

...

Keyword(s):

Cohort Study ◽

Mortality Rate ◽

Maternal Mortality ◽

Sickle Cell ◽

Pregnancy Outcomes ◽

Retrospective Cohort ◽

Mortality Rates ◽

Cell Disease ◽

Live Births ◽

The Us

Abstract Background: Women with sickle cell disease (SCD) are at high risk for obstetrical and SCD-related complications throughout pregnancy. Given the dearth of recent population-based studies on female reproductive health in SCD, we used hospitalization data from the socio-economically diverse state of California to describe peripartum outcomes in women with SCD. Methods: For our retrospective cohort study, we identified females with SCD who were either evaluated in the emergency department (ED) or hospitalized between the ages of 10-45 years from California's patient discharge dataset (1991-2016). We defined SCD severity by frequency of utilization with severe disease requiring an average of ≥ 3 hospitalizations and/or ED visits per year, and less severe with an annual rate of < 3 acute care visits. We used ICD-9/10-CM codes to identify all deliveries, and categorized pregnancy outcomes as either incomplete (hydatidiform mole, elective termination, miscarriage, and ectopic pregnancies) or delivery (live or stillbirths). We defined race/ethnicity as Black (or African American) vs. non-Black and quantified the total number of pregnancies for each patient. We described delivery age, mode (C-section vs. vaginal), outcome (live vs. stillbirth), median length of stay (LOS), and maternal mortality for the first in-hospital delivery. Results: Our cohort comprised 3,089 females with SCD of childbearing age, with a median follow-up of 11 years. Of the 1,108 (35.9%) women with at least one pregnancy, 1,000 (90.3%) were Black and 591 (53.3%) had severe SCD. Overall, we observed 2,330 pregnancies; of the 1,864 (80%) deliveries , 45% occurred via C-section (Figure 1). When we restricted our analysis to first deliveries only, 346 (36.0%) occurred in women ages 20-24 years; the next highest proportion of deliveries (23.4%) was in adolescents ages 15-19 years (Figure 2). Only 5.5% of deliveries occurred in women ≥ 35 years old. One hundred seventy-two (15.5%) first pregnancies were incomplete (Table 1), primarily due to miscarriage (59.3%). Of the women with incomplete first pregnancies, 69.2% had severe SCD; in contrast, 50.4% had severe SCD in the first delivered pregnancies' subset. Of the 936 first deliveries, 41.5% were by C-section with a median LOS of 5 days, compared with 3 days for those who delivered vaginally. Twenty-two first deliveries (2.4%) were stillbirth for a rate of 24.9 stillbirths per 1000 deliveries. Of the 862 live births, 5 women died, which resulted in an inpatient maternal mortality rate of 580.1 per 100,000 live births. Discussion Pregnant women with SCD first delivered in the hospital at a mean age of 24.1 years, which is younger than the US national mean of 26.8 years (all races) and 24.9 years (Black), based on 2017 maternal health data from the Centers for Disease Control and Prevention (CDC). We attribute this age difference to the higher proportion of first deliveries in adolescents with SCD coupled with the trend towards older age of first delivery in the general population. For first deliveries, 41.5% of women with SCD underwent a C-section, compared with a 2013 national average of 22.8% (all races) and 25.7% (Black) in primigravid women in the US. Stillbirths in our SCD cohort surpassed the 2014 national rates of 5.9 (all races) and 10.3 (Black) stillbirths per 1000 deliveries. Lastly, the inpatient maternal mortality rate in women with SCD, while based only on 5 deaths, far exceeds the 2014-2017 US maternal mortality rates of 17.3 (all races) and 41.7 (Black) deaths per 100,000 live births. Limitations include the lack of outpatient data, which likely resulted in an underestimation of the total number of pregnancies. Maternal mortality rates from the CDC cover death up to 12 months postpartum, so a comparable mortality rate for women with SCD might be higher. The striking disparities in outcomes in our study cohort, compared to national averages, suggests notable deficits in the optimal management of pregnancy in SCD. Analyses are ongoing to determine the effect of pregnancy on sickle-cell related complications, to evaluate the frequency of peripartum complications in women with SCD (e.g., venous thromboembolism, preeclampsia, and post-partum hemorrhage), and to compare rates of obstetrical complications in SCD vs non-SCD women, adjusted for social determinants of health. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Association between COVID-19 mortality and population level health and socioeconomic indicators

10.1101/2021.01.25.21250468 ◽

2021 ◽

Author(s):

Sasikiran Kandula ◽

Jeffrey Shaman

Keyword(s):

Chronic Kidney Disease ◽

Population Level ◽

Individual Characteristics ◽

Socioeconomic Indicators ◽

Vaccination Strategies ◽

The Us ◽

Spatial Autoregressive ◽

Us Counties ◽

Spatial Autoregressive Models ◽

Near Future

AbstractWith the availability of multiple COVID-19 vaccines and the predicted shortages in supply for the near future, it is necessary to allocate vaccines in a manner that minimizes severe outcomes. To date, vaccination strategies in the US have focused on individual characteristics such as age and occupation. In this study, we assess the utility of population-level health and socioeconomic indicators as additional criteria for geographical allocation of vaccines. Using spatial autoregressive models, we demonstrate that 43% of the variability in COVID-19 mortality in US counties can be explained by health/socioeconomic factors, adjusting for case rates. Of the indicators considered, prevalence of chronic kidney disease and proportion of population living in nursing homes were found to have the strongest association. In the context of vaccine rollout globally, our findings indicate that national and subnational estimates of burden of disease could be useful for minimizing COVID-19 mortality.

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Platelet Transfusions In Patients with Immune Thrombocytopenic Purpura (ITP) – Evaluation of the Current Nationwide Inpatient Hospital Practices.

Blood ◽

10.1182/blood.v116.21.3809.3809 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3809-3809 ◽

Cited By ~ 3

Author(s):

Lieu Tran ◽

Ruchika Goel ◽

Lakshmanan Krishnamurti

Keyword(s):

Mortality Rate ◽

Platelet Transfusion ◽

Mortality Rates ◽

Bleeding Complications ◽

Hospital Discharges ◽

Thrombocytopenic Purpura ◽

Major Bleed ◽

The Us ◽

Platelet Transfusions

Abstract Abstract 3809 Background. The role of platelet transfusions in the management of immune thrombocytopenic purpura (ITP) is debatable. The 2010 international consensus guidelines on the diagnosis and management of ITP (Blood, 2010) recommends that platelet transfusions be reserved for use when an urgent restoration in platelet count is needed, such as for patients who are bleeding and those preparing for surgery. To date, the nationwide practices of platelet transfusion in hospitalized ITP patients in the US have not been reported. Objective. This study aims to quantify the current nationwide in-hospital ITP related bleeding complications, platelet transfusion practices and the associated mortality rates. Methods. Data from the Nationwide Inpatient Sample (NIS) 2007, the largest all-payer inpatient database in the U.S. were used. NIS is a powerful database which gives a stratified probability sample of 20% of all hospital discharges among U.S. community hospitals (n = 1,044). Sampling weights were applied to represent all community hospital discharges in the US in 2007. ITP was identified using the ICD9 code 287.31. ITP related major bleed was defined to include intracranial hemorrhage (ICH), gastrointestinal bleed (GIB) and/or genitourinary bleed (GUB). Results. In 2007, there were 50,275±1,596 hospital discharges with ITP as one of the all listed diagnoses. Of these, 4,016±520 were children (≤17years). Platelet transfusions were administered in 14.3±0.6% of the total discharges. Of the pediatric discharges, 4.8±0.9% received platelets. At least one major bleed occurred in 9.0±0.3% of the ITP discharges. Among those with a major bleed, 31.2±1.8% received platelets. Platelet transfusions occurred in 34.9±3.4% of patients with epistaxis, in the absence of a major bleed. The mean age was 45.9±1.3 years for all hospitalized patient with ITP, 60.8±0.8 years for patients with a major bleed, and 58.3±0.7 years for recipients of platelet transfusions. For all patients with ITP, mortality rate was 3.6±2.0%. Mortality rate of 9.5±1.0% among patients with a major bleed, was significantly higher (p <0.001) than those without a major bleed (3.0±0.2%). There was no significant difference in mortality rate (p= 0.12) between patients who had a major bleed and received platelets (11.8±2.0%) and those who had a major bleed and did not receive platelets (8.5±1.5%). Conclusions. These data suggest that platelet transfusions are administered frequently in hospitalized patients with ITP in those who have bleeding complications and also in those who have epistaxis in the absence of a major bleed. Mortality rate is significantly higher in ITP patients with a major bleed as compared to those without a major bleed. Platelet transfusions in patients with major bleeds are not associated with improved mortality rates. The high rate of platelet transfusions with or without concomitant severe hemorrhage suggests the need for further studies to ascertain the role of platelet transfusion in the management of ITP. Disclosures: No relevant conflicts of interest to declare.

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Mortality, Ethnicity, and Urbanization Among Children Aged 1-4 Years on the US-Mexico Border

Public Health Reports ◽

10.1177/0033354918792013 ◽

2018 ◽

Vol 133 (5) ◽

pp. 593-600 ◽

Cited By ~ 3

Author(s):

Jill A. McDonald ◽

Lindsey Brantley ◽

Leonard J. Paulozzi

Keyword(s):

Mortality Rate ◽

The United States ◽

Mortality Rates ◽

Hispanic Children ◽

White Children ◽

Urbanization Level ◽

The Us ◽

Mexico Border ◽

Hispanic White ◽

Us Mexico Border

Objectives: Little is known about the mortality of children along the US-Mexico border. The objective of our study was to determine whether mortality rates among Hispanic children along the border (“border Hispanic children”) exceeded mortality rates among non-Hispanic white children along the border. Methods: We examined mortality rates from 2001-2015 for children aged 1-4 years in US-Mexico border counties and in the United States overall. We compared mortality rates among Hispanic and non-Hispanic white children by county urbanization level (large central, medium, and small metropolitan; micropolitan nonmetropolitan; and noncore nonmetropolitan). Results: During 2001-2015, 1811 children aged 1-4 years died in the border region. The mortality rate per 100 000 children among border Hispanic children (28.3; 95% confidence interval [CI], 26.8-29.9) exceeded the mortality rate of US Hispanic children (24.7; 95% CI, 24.3-25.1) and border non-Hispanic white children (23.2; 95% CI, 20.8-25.6). When stratified by county urbanization level, however, mortality rates of border Hispanic children were not significantly different from mortality rates of US Hispanic or border non-Hispanic white children. Mortality rates in noncore nonmetropolitan counties were twice those in large central metropolitan counties, with injury mortality accounting for most of the excess. Mortality rates increased in nonmetropolitan border counties after 2010. Conclusions: Increased risk for injury and disease in noncore nonmetropolitan counties might be related to poverty, reduced access to care, or poorer quality of care. Future research should identify the remediable risk factors in such communities as the next step in preventing deaths among children aged 1-4 years.

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1315Influence of comorbidity on mortality in patients with Rheumatoid Arthritis 1980-2015: A longitudinal population-based study

International Journal of Epidemiology ◽

10.1093/ije/dyab168.033 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Khalid Almutairi ◽

Johannes Nossent ◽

David Preen ◽

Helen Keen ◽

Charles Inderjeeth

Keyword(s):

Rheumatoid Arthritis ◽

Mortality Rate ◽

General Population ◽

Western Australia ◽

Population Level ◽

Mortality Rates ◽

Population Based ◽

Icd 10 ◽

Hospital Morbidity ◽

Rate Ratios

Abstract Background To describe temporal changes in mortality rates for patients with Rheumatoid arthritis (RA) in relation to comorbidity accrual from 1980-2015 in Western Australia (WA). Methods Using population-level linked data from WA health administrative datasets (hospital morbidity, emergency department and death data) we followed 17,125 RA patients (ICD-10-AM M05.00–M06.99, ICD-9-CM 714) from 1980- 2015. Comorbidity was ascertained using the Charlson Comorbidity Index (CCI). Mortality rate ratios (MRR) were calculated per decade between the RA cohort and the WA general population by direct age standardisation method, Results During 356,069 patient-years, a total of 8955 (52%) deaths occurred in the RA cohort. The highest prevalence of comorbidity (688.6 per 1000 separations) was in the period 1991-2000 following a 1.3% average annual increase since 1980. In-hospital mortality rate was highest (26.7 deaths per 1000 separations) in the same period. After 2001, both RA comorbidity and mortality rates decreased annually by -0.5% and -4.8%, respectively, with annual changes of -4.4% to -2% and from 2011-2015, respectively. The overall mortality rate in RA patients after age adjustment was 2.5-times (95%CI: 2.52-2.65) higher than the general population between 1980-2015 and 1.5-times (95%CI: 1.39-1.81) for 2011-2015. Conclusions The annual comorbidity prevalence and mortality rates in WA have decreased significantly since 2001 reflecting improvements in the management of RA and comorbidity. Key messages The mortality rate in Rheumatoid Arthritis patients in Western Australia remains 1.5-times higher than their community.

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