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- Title
Prevalence, incidence and cause-specific mortality of rheumatoid arthritis–associated interstitial lung disease among older rheumatoid arthritis patients.
- Authors
Sparks, Jeffrey A; Jin, Yinzhu; Cho, Soo-Kyung; Vine, Seanna; Desai, Rishi; Doyle, Tracy J; Kim, Seoyoung C
- Abstract
Objective We aimed to investigate the prevalence, incidence and cause-specific mortality of RA-associated interstitial lung disease (RA-ILD) among older US patients with RA. Methods We performed a nationwide cohort study using Medicare claims data (parts A, B and D for 2008–2017). RA was identified with a validated algorithm using RA diagnosis codes and DMARD prescription. RA-ILD was identified with a validated algorithm using ILD diagnosis codes by a rheumatologist/pulmonologist. RA-ILD was categorized as prevalent or incident relative to the initial RA observation (baseline/index date). We compared the total mortality of RA-ILD to RA without ILD using multivariable Cox regression, adjusting for baseline covariates. For cause-specific mortality, Fine and Gray subdistribution hazard ratios (sdHRs) were estimated to handle competing risks of alternative mortality causes. Results Among 509 787 RA patients (mean age 72.6 years, 76.2% female), 10 306 (2.0%) had prevalent RA-ILD at baseline. After baseline, 13 372 (2.6%) developed RA-ILD during 1 873 127 person-years of follow-up (median 3.0 years/person). During follow-up, 38.7% of RA-ILD patients died compared with 20.7% of RA patients without ILD. After multivariable adjustment, RA-ILD had an HR of 1.66 (95% CI 1.60, 1.72) for total mortality. Accounting for competing risk of other causes of death, RA-ILD had an sdHR of 4.39 (95% CI 4.13, 4.67) for respiratory mortality and an sdHR of 1.56 (95% CI 1.43, 1.71) for cancer mortality compared with RA without ILD. Conclusions RA-ILD was present or developed in nearly 5% of patients in this nationwide study of older patients with RA. Compared with RA without ILD, RA-ILD was associated with excess total, respiratory and cancer mortality that was not explained by measured factors.
- Subjects
UNITED States; CONFIDENCE intervals; MULTIVARIATE analysis; INTERSTITIAL lung diseases; COMPARATIVE studies; RHEUMATOID arthritis; DISEASE prevalence; DESCRIPTIVE statistics; LONGITUDINAL method; MEDICARE; ALGORITHMS
- Publication
Rheumatology, 2021, Vol 60, Issue 8, p3689
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keaa836