FRI0064 INCREASE OF RHEUMATOID ARTHRITIS AS A CONTRIBUTORY CAUSE OF DEATH IN THE ELDERLY. A NATIONWIDE STUDY IN ITALY, 2003–2015

Abstract

Background Metanalyses failed to show a decrease of the mortality risk in cohorts of patients with rheumatoid arthritis (RA) between 1950 and 1995. Mortality rates obtained with the analysis of multiple causes of death (MCD) can provide a more complete estimate of the burden of mortality related to RA compared to analysis considering only the underlying cause of death (UCD). Such analyses are available from a limited number of countries, and trends for RA mortality based on MCD were divergent. Objectives The objective of the study was to evaluate trends of rheumatoid arthritis (RA) mortality reported as the underlying cause of death (UCD) and as multiple cause of death (MCD) in Italy between 2003 and 2015. Methods Analyses were carried out on the Italian National Cause of Death Register, managed by the Italian National Institute of Statistics (ISTAT). Diseases mentioned in the death certificate are coded according to the International Classification of Diseases, 10th Edition (ICD-10, 2009 version). Deaths from January 1, 2003 to December 31, 2015 with mention of RA were included. Time trends of age-standardized rates were analyzed for RA both as UCD and MCD; and the annual percent change (APC) was estimated. Results Overall 26,564 deaths with mention of RA were retrieved out of 7,595,214 deaths (0.35% of all certificates). The yearly number of RA-related deaths increased through the study period, meanwhile the probability of selection as the UCD decreased: MCD/UCD ratio was 3.7 in 2003-2006 and 4.8 in 2012-2015 in males; 3.0 and 4.1 in females (Tab.). Mortality rates based on the UCD decreased (males APC -3.1%, CI -3.9, -2.3; females APC -3.3%, CI -4.1, -2.4); while MCD rates for RA-related mortality were stable. Specifically, rates were stable or declined among younger subjects, whereas an increase was registered for the elderly: RA-related deaths in subjects aged ≥80 years raised from 48% in 2003-2006 to 59% in 2012-2015 (Fig.). Conclusion RA is increasingly mentioned among diseases contributing to death in Italy. Rheumatoid arthritis declined as underlying cause of death in the last decades. We observed a shift of RA-related mortality towards the elderly, possibly because of the progress in therapeutic strategies allowing increased survival of RA patients. Disclosure of Interests None declared