Risk of mortality among people with rheumatoid arthritis and depression

Abstract

Aim of the work: To investigate the mortality risk in a random sample of community-dwelling adult Americans with rheumatoid arthritis (RA), depression, or both. Patients and methods: National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 on American adults aged 30 years and older were analyzed after linking individual participant data with mortality files from the National Death Index (NDI) up to December 31, 2019. Sociodemographic and health-related variables were accounted for in the multivariable analysis. The average duration of follow-up to mortality for participants was 9.6 years. Results: A total of 22,155 adult Americans were included in the final sample where 1,670 had RA. Females, older, widowed or divorced, and those with lower education or income levels were statistically significantly more likely to have RA. Individuals with RA were also more likely to smoke, have higher BMI, or history of hypertension, cancer, or cardiovascular diseases (CVD). In adjusted analysis, no significant difference was found for mortality between those with and without RA (HR = 1.24, 95 % CI = 0.60–2.59). However, the risk of mortality was statistically significantly higher in participants with both RA and depression (HR = 2.44, 95 %CI = 1.14–5.21). Smoking, age, and income were consistent moderators for the relationship between RA or depression and mortality. Conclusions: Depression increases the likelihood of premature mortality among those with RA. Psychotherapeutic and pharmacotherapy interventions should be implemented using collaborative and interdisciplinary care teams for those with RA and depression. Aggressive management of comorbidities and providing smoking cessation interventions are also warranted for people with both RA and depression.