Anticitrullinated protein antibodies and rheumatoid factor are associated with increased mortality but with different causes of death in patients with rheumatoid arthritis: a longitudinal study in three European cohorts

ObjectivePatients with rheumatoid arthritis (RA)-related autoantibodies have an increased mortality rate. Different autoantibodies are frequently co-occurring and it is unclear which autoantibodies associate with increased mortality. In addition, association with different causes of death is thus far unexplored. Both questions were addressed in three early RA populations.Methods2331 patients with early RA included in Better Anti-Rheumatic Farmaco-Therapy cohort (BARFOT) (n=805), Norfolk Arthritis Register (NOAR) (n=678) and Leiden Early Arthritis Clinic cohort (EAC) (n=848) were studied. The presence of anticitrullinated protein antibodies (ACPA), rheumatoid factor (RF) and anticarbamylated protein (anti-CarP) antibodies was studied in relation to all-cause and cause-specific mortality, obtained from national death registers. Cox proportional hazards regression models (adjusted for age, sex, smoking and inclusion year) were constructed per cohort; data were combined in inverse-weighted meta-analyses.ResultsDuring 26 300 person-years of observation, 29% of BARFOT patients, 30% of NOAR and 18% of EAC patients died, corresponding to mortality rates of 24.9, 21.0 and 20.8 per 1000 person-years. The HR for all-cause mortality (95% CI) was 1.48 (1.22 to 1.79) for ACPA, 1.47 (1.22 to 1.78) for RF and 1.33 (1.11 to 1.60) for anti-CarP. When including all three antibodies in one model, RF was associated with all-cause mortality independent of other autoantibodies, HR 1.30 (1.04 to 1.63). When subsequently stratifying for death cause, ACPA positivity associated with increased cardiovascular death, HR 1.52 (1.04 to 2.21), and RF with increased neoplasm-related death, HR 1.64 (1.02 to 2.62), and respiratory disease-related death, HR 1.71 (1.01 to 2.88).ConclusionsThe presence of RF in patients with RA associates with an increased overall mortality rate. Cause-specific mortality rates differed between autoantibodies: ACPA associates with increased cardiovascular death and RF with death related to neoplasm and respiratory disease.

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EXCESS MORTALITY FROM COVID-19. WEEKLY EXCESS DEATH RATES BY AGE AND SEX FOR SWEDEN AND ITS MOST AFFECTED REGION

European Journal of Public Health ◽

10.1093/eurpub/ckaa218 ◽

2020 ◽

Author(s):

Karin Modig ◽

Anders Ahlbom ◽

Marcus Ebeling

Keyword(s):

Causes Of Death ◽

Excess Mortality ◽

National Level ◽

Mortality Rates ◽

Regional Level ◽

Death Rates ◽

Excess Death ◽

All Cause Mortality ◽

Specific Mortality ◽

Age And Sex

Abstract Background Sweden has one of the highest numbers of COVID-19 deaths per inhabitant globally. However, absolute death counts can be misleading. Estimating age- and sex-specific mortality rates is necessary in order to account for the underlying population structure. Furthermore, given the difficulty of assigning causes of death, excess all-cause mortality should be estimated to assess the overall burden of the pandemic. Methods By estimating weekly age- and sex-specific death rates during 2020 and during the preceding five years, our aim is to get more accurate estimates of the excess mortality attributed to COVID-19 in Sweden, and in the most affected region Stockholm. Results Eight weeks after Sweden’s first confirmed case, the death rates at all ages above 60 were higher than for previous years. Persons above age 80 were disproportionally more affected, and men suffered greater excess mortality than women in ages up to 75 years. At older ages, the excess mortality was similar for men and women, with up to 1.5 times higher death rates for Sweden and up to 3 times higher for Stockholm. Life expectancy at age 50 declined by less than 1 year for Sweden and 1.5 years for Stockholm compared to 2019. Conclusions The excess mortality has been high in older ages during the pandemic, but it remains to be answered if this is because of age itself being a prognostic factor or a proxy for comorbidity. Only monitoring deaths at a national level may hide the effect of the pandemic on the regional level.

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Why Residents of South China live longer than those of North China?

10.21203/rs.2.18962/v1 ◽

2019 ◽

Author(s):

yi huang ◽

Mengqi Wang ◽

Yanxin Song ◽

Shuangping Zhang

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

South China ◽

North China ◽

Mortality Rates ◽

Overweight And Obesity ◽

Salt Consumption ◽

All Cause Mortality ◽

Specific Mortality ◽

North And South

Abstract Background: Since 1990, life expectancy and nonagenarian ratio in South China have been higher than those in North China.Methods: To determine the reason residents of South China live longer, we calculated age-specific mortality rates (per 100,000 people) in North and South China. We examined the associations between the provincial mortality rates due to major fatal diseases and life span indicator.Results: CVD is the leading cause of death in China. The proportion of CVD in all-cause mortality increases with age, and its mortality rate accounts for over 50% of all-cause mortalities in people aged over 80 years. Moreover, the mortality rate of CVD gradually decreases from north to south, indicating the main reason of difference in longevity between North and South China. This difference can be attributed to variations in temperature, salt consumption, selenium intake, air pollution, overweight and obesity between the two regions. Lower mortality rates of individuals aged 55–89 years in South China lead to higher longevity level. Provincial gravity centers of the proportion of longevity population move southward, and this shift is accelerated with increasing age.Conclusions: the mortality rate of CVD gradually decreases from north to south is the reason residents of South China live longer, and risk factors of CVD gradually decreases from north to south.

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The Characteristics and Mortality of Osteoporosis, Osteomyelitis, or Rheumatoid Arthritis in the Diabetes Population: A Retrospective Study

International Journal of Endocrinology ◽

10.1155/2020/8821978 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Jin-Feng Huang ◽

Qi-Nan Wu ◽

Xuan-Qi Zheng ◽

Xiao-Lei Sun ◽

Chen-Yu Wu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Diabetes Mellitus ◽

Retrospective Study ◽

Mortality Rate ◽

Causes Of Death ◽

Treatment Strategies ◽

Mortality Rates ◽

Crude Mortality ◽

Patients With Diabetes ◽

Icd 10

Background. Patients with diabetes mellitus are prone to develop osteoporosis, osteomyelitis, or rheumatoid arthritis (RA). Furthermore, the presence of these complications in those with diabetes may lead to higher mortality. The aim of our study was to assess characteristics and mortality of osteoporosis, osteomyelitis, or rheumatoid arthritis in individuals with diabetes. Methods. We analyzed osteoporosis, osteomyelitis, and RA deaths associated with diabetes from 1999–2017 using the CDC WONDER system (CDC WONDER; https://wonder.cdc.gov). We used ICD-10 codes to categorize the underlying and contributing causes of death. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 1,000,000 person-years were calculated. Results. The AAMR for osteoporosis in the population with diabetes was significantly higher in females (AAMR: 4.17, 95% CI: 4.10–4.24) than in males (AAMR: 1.12, 95% CI: 1.07–1.16). Deaths due to osteoporosis increased gradually from 1999, peaked in 2003 (AAMR: 3.78, 95% CI: 3.55–4.00), and reached a nadir in 2016 (AAMR: 2.32, 95% CI: 2.15–2.48). The AAMR for RA associated with diabetes was slightly higher in females (AAMR: 4.04, 95% CI: 3.98–4.11) than in males (AAMR: 2.45, 95% CI: 2.39–2.51). The mortality rate due to RA increased slightly from 1999 (AAMR: 3.18, 95% CI: 2.97–3.39) to 2017 (AAMR: 3.20, 95% CI: 3.02–3.38). The AAMR for osteomyelitis associated with diabetes was higher in males (AAMR: 4.36, 95% CI: 4.28–4.44) than in females (AAMR: 2.31, 95% CI: 2.26–2.36). From 1999 to 2017, the AAMR from osteomyelitis in this population was 2.63 (95% CI: 2.44–2.82) per 1,000,000 person-years in 1999 and 4.25 (95% CI: 4.05–4.46) per 1,000,000 person-years in 2017. Conclusions. We found an increase in the age-adjusted mortality rates of RA and osteomyelitis and a decrease of osteoporosis associated with diabetes from 1999 to 2017. We suggest that increased attention should therefore be given to these diseases in the population with diabetes, especially in efforts to develop preventative and treatment strategies.

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All-cause and cause-specific mortality during and following incarceration in Brazil: A retrospective cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003789 ◽

2021 ◽

Vol 18 (9) ◽

pp. e1003789

Author(s):

Yiran E. Liu ◽

Everton Ferreira Lemos ◽

Crhistinne Cavalheiro Maymone Gonçalves ◽

Roberto Dias de Oliveira ◽

Andrea da Silva Santos ◽

...

Keyword(s):

Retrospective Cohort ◽

Causes Of Death ◽

Mortality Rates ◽

Communicable Diseases ◽

Violent Death ◽

Insufficient Data ◽

Risk Of Death ◽

All Cause Mortality ◽

Specific Mortality ◽

Over Time

Background Mortality during and after incarceration is poorly understood in low- and middle-income countries (LMICs). The need to address this knowledge gap is especially urgent in South America, which has the fastest growing prison population in the world. In Brazil, insufficient data have precluded our understanding of all-cause and cause-specific mortality during and after incarceration. Methods and findings We linked incarceration and mortality databases for the Brazilian state of Mato Grosso do Sul to obtain a retrospective cohort of 114,751 individuals with recent incarceration. Between January 1, 2009 and December 31, 2018, we identified 3,127 deaths of individuals with recent incarceration (705 in detention and 2,422 following release). We analyzed age-standardized, all-cause, and cause-specific mortality rates among individuals detained in different facility types and following release, compared to non-incarcerated residents. We additionally modeled mortality rates over time during and after incarceration for all causes of death, violence, or suicide. Deaths in custody were 2.2 times the number reported by the national prison administration (n = 317). Incarcerated men and boys experienced elevated mortality, compared with the non-incarcerated population, due to increased risk of death from violence, suicide, and communicable diseases, with the highest standardized incidence rate ratio (IRR) in semi-open prisons (2.4; 95% confidence interval [CI]: 2.0 to 2.8), police stations (3.1; 95% CI: 2.5 to 3.9), and youth detention (8.1; 95% CI: 5.9 to 10.8). Incarcerated women experienced increased mortality from suicide (IRR = 6.0, 95% CI: 1.2 to 17.7) and communicable diseases (IRR = 2.5, 95% CI: 1.1 to 5.0). Following release from prison, mortality was markedly elevated for men (IRR = 3.0; 95% CI: 2.8 to 3.1) and women (IRR = 2.4; 95% CI: 2.1 to 2.9). The risk of violent death and suicide was highest immediately post-release and declined over time; however, all-cause mortality remained elevated 8 years post-release. The limitations of this study include inability to establish causality, uncertain reliability of data during incarceration, and underestimation of mortality rates due to imperfect database linkage. Conclusions Incarcerated individuals in Brazil experienced increased mortality from violence, suicide, and communicable diseases. Mortality was heightened following release for all leading causes of death, with particularly high risk of early violent death and elevated all-cause mortality up to 8 years post-release. These disparities may have been underrecognized in Brazil due to underreporting and insufficient data.

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Why Residents of South China live longer than those of North China?

10.21203/rs.2.17818/v1 ◽

2019 ◽

Author(s):

yi huang ◽

Mengqi Wang ◽

Yanxin Song ◽

Shuangping Zhang

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

South China ◽

North China ◽

Mortality Rates ◽

Overweight And Obesity ◽

Salt Consumption ◽

All Cause Mortality ◽

Specific Mortality ◽

North And South

Abstract Background, Since 1990, life expectancy and nonagenarian ratio in South China have been higher than those in North China. Methods, To determine the reason residents of South China live longer, we calculated age-specific mortality rates (per 100,000 people) in North and South China. We examined the associations between the provincial mortality rates due to major fatal diseases and life span indicator. Results, CVD is the leading cause of death in China. The proportion of CVD in all-cause mortality increases with age, and its mortality rate accounts for over 50% of all-cause mortalities in people aged over 80 years. Moreover, the mortality rate of CVD gradually decreases from north to south, indicating the main reason of difference in longevity between North and South China. This difference can be attributed to variations in temperature, salt consumption, selenium intake, air pollution, overweight and obesity between the two regions. Lower mortality rates of individuals aged 55–89 years in South China lead to higher longevity level. Provincial gravity centers of the proportion of longevity population move southward, and this shift is accelerated with increasing age. Conclusions, the mortality rate of CVD gradually decreases from north to south is the reason residents of South China live longer, and risk factors of CVD gradually decreases from north to south.

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Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank

10.2337/figshare.16965199 ◽

2021 ◽

Author(s):

Han Han ◽

Yaying Cao ◽

Chengwu Feng ◽

Yan Zheng ◽

Klodian Dhana ◽

...

Keyword(s):

Type 2 Diabetes ◽

Respiratory Disease ◽

Digestive Disease ◽

Diabetes Management ◽

Healthy Lifestyle ◽

Population Attributable Risk ◽

Uk Biobank ◽

All Cause Mortality ◽

Specific Mortality

<a>Objective: </a><a></a><a></a><a></a><a></a><a>To evaluate the association of a healthy lifestyle, involving seven low-risk factors mentioned in diabetes management guidelines (no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, less sedentary behavior, adequate sleep duration, and appropriate social connection), with all-cause and cause-specific mortality among individuals with type 2 diabetes.</a> Research Design and Methods: This study included 13,366 participants with baseline type 2 diabetes from the UK Biobank free of CVD or cancer. Lifestyle information was collected through a baseline questionnaire. <a>Results: During a median follow-up of 11.7 years, 1,561 deaths were documented, with 625 from cancer, 370 from CVD, 115 from respiratory disease, 81 from digestive disease, and 74 from neurodegenerative disease.</a><a> In multivariate-adjusted model, each lifestyle factor was significantly associated with all-cause mortality and hazard ratios (95% CIs) associated with the lifestyle score (scoring 6-7 vs. 0-2 unless specified) were 0.42 (0.34, 0.52) for all-cause mortality, 0.57 (0.41, 0.80) for cancer mortality, 0.35 (0.22, 0.56) for CVD mortality, 0.26 (0.10, 0.63) for respiratory mortality, and 0.28 (0.14, 0.53) for digestive mortality (scoring 5-7 vs. 0-2). In the population-attributable-risk analysis, 27.1% (95% CI: 16.1, 38.0%) death was attributable to a poor lifestyle (scoring 0-5). </a><a>The association between a healthy lifestyle and all-cause mortality was consistent, irrespective of factors reflecting diabetes severity (diabetes duration, glycemic control, diabetes-related microvascular disease, and diabetes medication)</a>. Conclusions: <a></a><a></a>A healthy lifestyle was associated with a lower risk of mortality due to all-cause, CVD, cancer, respiratory disease, and digestive disease among individuals with type 2 diabetes.

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Drug Overdose Trends among Black Indiana Residents: 2013-2017

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v11i1.9916 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Raven Helmick

Keyword(s):

Mortality Rate ◽

Drug Overdose ◽

Rate Increase ◽

Mortality Rates ◽

Time Frame ◽

Minority Population ◽

Racial Inequalities ◽

Specific Mortality ◽

Overdose Mortality ◽

Overdose Deaths

ObjectiveTo understand trends in race-specific mortality rates between blacks and whites to discover any racial inequalities that might exist for drug overdose deaths. To delve into the types of drugs that are prominently involved in black drug overdose deaths from 2013-2017 in the state of Indiana.IntroductionBlack Hoosiers, the largest minority population in Indiana, make up almost 10% of the state’s population, and accounted for 8% of the total resident drug overdose deaths from 2013-2017 compared to whites at 91%. However, a closer look at race-specific mortality rates might reveal racial inequalities. Therefore, the purpose of this project was to analyze drug overdose morality rates among white and black Hoosiers to discover possible racial inequalities and to discover trends in drug involvement in overdose deaths among blacks.MethodsDrug overdose deaths that occurred in Indiana between 2013 and 2017 were identified using the underlying and contributing cause of death ICD-10 codes and abstracted from the Indiana State Department of Health’s annual finalized mortality dataset. Race-specific drug overdose death rates were calculated and compared among racial groups. Drug overdose deaths in blacks were examined for trends over time and by the types of drugs involved.ResultsBetween 2013 and 2017, drug overdose mortality rates for whites increased from 17.05 to 27.28 per 100,000. Blacks saw a higher rate increase during this same time frame: from 10.74 to 30.62 per 100,000, surpassing the mortality rate of whites by the end of 2017. Drug overdose deaths in blacks increased 197% from 2013-2017 and drug specific mortality rate increases were seen across all drug category’s. Opioids, which were involved in 61% of the 2017 drug overdose deaths among blacks, had a rate increase from 3.05 to 18.62 per 100,000 between 2013 and 2017. Drug specific overdose mortality rate increases were also seen for overdoses involving cocaine (1.76 to 10.62 per 100,000), benzodiazepines (0.32 to 3.08 per 100,000), and psychostimulants other than cocaine (0.16 to 1.69 per 100,000) such as amphetamines.ConclusionsWhile white Hoosiers had higher drug overdose mortality rates between 2013 and 2016, black Hoosiers had a greater mortality rate increase and surpassed the mortality rate in whites in 2017. Opioids, the most frequently involved substance in overdose deaths among blacks from 2013-2017, showed increasing rates during this time period. However, increases in drug specific overdose mortality rates for cocaine, benzodiazepines, and psychostimulants other than cocaine also call for public health attention. These results promote the inclusion of minority health experts in drug overdose prevention efforts and issue a call for future prevention efforts to be targeted toward the state’s largest minority population.

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Characteristics of mortality in the Orenburg region population in 2011-2017

Science and Innovations in Medicine ◽

10.35693/2500-1388-2020-5-2-99-104 ◽

2020 ◽

Vol 5 (2) ◽

pp. 99-104

Author(s):

Evgenii L. Borschuk ◽

Dmitrii N. Begun ◽

Tatyana V. Begun

Keyword(s):

Mortality Rate ◽

Causes Of Death ◽

Age Groups ◽

Circulatory System ◽

Mortality Rates ◽

Female Population ◽

Orenburg Region ◽

The Third ◽

Circulatory System Diseases ◽

External Causes

Objectives - to study the mortality indicators, their dynamics and structure, in the population of the Orenburg region in the period of 2011-2017. Material and methods. The study was conducted using the data from the territorial authority of statistics in the Orenburg region in the period from 2011 to 2017. The analytical, demographic and statistical methods were implemented for the study of the demographic indicators. Results. Cities and municipal settlements of the Orenburg region with high mortality indicators were included in the second and fourth clusters during the cluster analysis. The first and third clusters included cities and municipal settlements with an average mortality. The most favorable position has the Orenburg area with the lowest mortality rate in the region in 2017 - 8.4%. The dynamics of mortality rates among the male and female population tends to decrease, more pronounced dynamics is in men. Though, the male population is characterized by higher mortality rates in all age groups. The leading position among the causes of death is taken by diseases of the circulatory system (46.3% of the total mortality). The second position is occupied by tumors (17.2%), the third - by external causes (8.4%). Mortality from circulatory system diseases and from external causes has reduced. The dynamics of mortality from tumors does not change significantly. The rank of leading causes of death is not identical in the clusters: in the third and fourth clusters, the other causes occupy the second place in the structure of mortality, while tumors occupy the third. Conclusion. In the Orenburg region, the mortality rate is higher than overage in the Russian Federation by 0.9 per 1000 people. The study revealed significant territorial differences in the mortality rates. In general, the mortality among men in all age groups is higher than the mortality of women. The mortality rate from diseases of the circulatory system plays the leading role in the structure of mortality, but has the tendency for decline. Until 2006, the mortality from external causes ranked the second place, now the second place is taken by death from tumors The mortality from external causes is decreasing; mortality from tumors does not change significantly. The obtained results could be used by local authorities in developing the program of public health protection and assessing its effectiveness.

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Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls

Rheumatology ◽

10.1093/rheumatology/keaa267 ◽

2020 ◽

Vol 60 (1) ◽

pp. 207-216

Author(s):

Irene E M Bultink ◽

Frank de Vries ◽

Ronald F van Vollenhoven ◽

Arief Lalmohamed

Keyword(s):

Mortality Rate ◽

Lupus Erythematosus ◽

Mortality Rates ◽

Cox Proportional Hazards ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Risk Of Mortality ◽

Increased Risk ◽

Specific Mortality ◽

Age And Sex

Abstract Objectives We wanted to estimate the magnitude of the risk from all-cause, cause-specific and sex-specific mortality in patients with SLE and relative risks compared with matched controls and to evaluate the influence of exposure to medication on risk of mortality in SLE. Methods We conducted a population-based cohort study using the Clinical Practice Research Datalink, Hospital Episode Statistics and national death certificates (from 1987 to 2012). Each SLE patient (n = 4343) was matched with up to six controls (n = 21 780) by age and sex. Cox proportional hazards models were used to estimate overall and cause-specific mortality rate ratios. Results Patients with SLE had a 1.8-fold increased mortality rate for all-cause mortality compared with age- and sex-matched subjects [adjusted hazard ratio (HR) = 1.80, 95% CI: 1.57, 2.08]. The HR was highest in patients aged 18–39 years (adjusted HR = 4.87, 95% CI: 1.93, 12.3). Mortality rates were not significantly different between male and female patients. Cumulative glucocorticoid use raised the mortality rate, whereas the HR was reduced by 45% with cumulative low-dose HCQ use. Patients with SLE had increased cause-specific mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide, whereas the mortality rate for cancer was reduced in comparison to controls. Conclusion British patients with SLE had a 1.8-fold increased mortality rate compared with the general population. Glucocorticoid use and being diagnosed at a younger age were associated with an increased risk of mortality. HCQ use significantly reduced the mortality rate, but this association was found only in the lowest cumulative dosage exposure group.

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