Trends in Cardiovascular Mortality Related to Rheumatoid Arthritis Among U.S. Adults, 1999–2023

Abstract

Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease frequently accompanied by extra-articular manifestations, particularly cardiovascular disease (CVD), which contributes substantially to morbidity and mortality. Although RA is a well-recognized risk factor for CVD, population-based studies describing long-term trends in RA-related CVD mortality in the United States remain limited. Methods: Mortality data on RA-related CVD among U.S. adults aged ≥25 years from 1999 to 2023 were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. RA and CVD were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Age-adjusted mortality rates (AAMRs, per 100,000 population) were calculated for demographic subgroups. Joinpoint regression was applied to estimate annual percent change (APC) and average annual percent change (AAPC). Results: From 1999 to 2023, a total of 63406 deaths from RA-related CVD occurred among U.S. adults. Stratified analyses showed that female deaths were twice as common as male deaths, with an AAMR of 1.14 per 100,000 population (95% CI:1.09–1.19) compared to 0.57 per 100,000 (95% CI: 0.52– 0.61) in males. Among the four U.S. Census regions, the Northeast had the lowest AAMR at 0.71 per 100,000 (95% CI: 0.61–0.82). Non-Hispanic (NH) Whites had the highest AAMR (0.97), whereas other NH groups had the lowest (0.86). Rural areas had a higher AAMR (1.11) compared to urban areas (0.85). Ischemic heart disease accounted for the largest proportion of CVD-related deaths among individuals with RA (AAMR: 0.37 per 100,000). Conclusion: This study describes long-term temporal trends and demographic disparities in RA-related CVD mortality in the United States. The recent increase in mortality warrants further investigation and may reflect multiple contributing factors, including population changes, healthcare access, and broader public health influences such as the COVID-19 pandemic. These findings identify population subgroups with disproportionately high mortality and highlight the need for further research to better understand underlying mechanisms and potential preventive strategies.