All-cause and cause-specific mortality of patients with rheumatoid arthritis in Korea: A nation-wide population-based study

Eunyoung Emily Lee, Anna Shin, Joongyub Lee, Joo Ho Lee, You Jung Ha, Yun Jong Lee, Eun Bong Lee, Yeong Wook Song, Eun Ha Kang

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Objective: To compare all-cause and cause-specific mortality between rheumatoid arthritis (RA) patients versus the general population of Korea. Methods: A nationally representative RA population aged ≥ 40 years was identified from Korea National Health Insurance Service (KNHIS) database. We estimated age- and sex-adjusted all-cause and cause-specific standardized mortality ratios (SMRs) with 95% confidence intervals (CIs), comparing RA patients to the general population. Subgroup analyses were done by sex, age group, calendar year, and biologics use. Results: We identified 79,352 RA patients with 6404 deaths during 2011–2016. The all-cause SMR [95% CI] of RA patients compared to the general population was 1.53 [1.49–1.56]. The top five causes of death were cancer (19.5%), respiratory disease (19.1%), cardiovascular disease (18.8%), systemic rheumatic diseases (9.5%, 9.1% due to RA), and infection (6.1%). Cause-specific SMRs [95% CI] were 0.95 [0.90–1.01] for cancer, 3.34 [3.15–3.52] for respiratory disease, 1.26 [1.18–1.33] for cardiovascular disease, 3.41 [3.08–3.75] for infection, and 4.88 [3.10–6.65] for non-RA systemic rheumatic disease. The SMR of RA population was slightly higher among men than women, and highest in their 60s and 70s. The yearly SMR increased from 1.10 [1.01–1.18] in 2011 to 1.85 [1.75–1.95] in 2016 due to population aging and comorbidity accumulation. Users of biologics showed a higher SMR than non-users (1.82 [1.69–1.96] vs. 1.50 [1.46–1.54]), due to higher RA activity, and more comorbidities despite a younger mean age. Conclusion: RA patients in Korea experienced 1.5-fold increase in all-cause mortality compared to the general population. Except for cancer, the top five causes of death were associated with excess mortality among RA patients. RA-associated mortality was largely determined by age, RA activity, and comorbidity status.

Original languageEnglish
Article number105269
JournalJoint Bone Spine
Issue number1
StatePublished - Jan 2022


  • Biologics
  • Cause-specific
  • Mortality
  • Rheumatoid arthritis


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