Mortality in rheumatoid arthritis: experience in four clinical series compared with the experience in the 1983 medical impairment study.

BACKGROUND Survival curves and decimal Standardized Mortality Ratios (SMRs) were reported in 1994 for four clinical series of patients with Rheumatoid Arthritis (RA), with use of a common data processing system. It was felt to be desirable to compare the excess mortality observed in clinical patients with the excess mortality found in substandard policyholders with RA in the 1983 Medical Impairment Study. RESULTS The weighted mean SMR was 2.25 for the male RA patients and 2.42 for the females. Although similar in magnitude to the percentage male and female Mortality Ratios (MRs) in the 1983 Medical Impairment Study, the derived Excess Death Rate (EDR) was higher for the clinical RA patients, despite the lower select mortality versus the population mortality, even after adjustment for difference in mean age between the clinical and insurance series. CONCLUSION The higher EDR in four clinical series of RA patients probably reflects a higher proportion of more severe cases, who are declined for insurance or do not accept a highly rated offer.