{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:53:45Z","timestamp":1784872425528,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Objectives: To evaluate associations between social vulnerability and rheumatoid arthritis (RA)-related mortality in the United States, with emphasis on domain-specific effects of the Social Vulnerability Index (SVI). Methods: We conducted a county-level ecological study of RA-related mortality from 2010 to 2019 using age-adjusted mortality rates and the Centers for Disease Control and Prevention SVI. Gamma regression models examined associations between RA mortality and overall SVI and four thematic domains, including socioeconomic status, household composition and disability, minority status and language, housing type and transportation by using both continuous and quartile-based measures. Results: Between 2010 and 2019, 354,280 deaths occurred among individuals with RA, corresponding to a mean age-adjusted mortality rate of 9.7 per 100,000 population. In multivariable analyses adjusting for all SVI domains, household composition and disability vulnerability demonstrated the strongest and most consistent positive association with mortality, with a dose\u2013response relationship across quartiles. Housing type and transportation vulnerability showed a modest positive association. Minority status and language vulnerability was inversely associated with mortality, whereas socioeconomic vulnerability was not significant in continuous models but demonstrated an inverse association with mortality in quartile-based analyses. Conclusions: RA mortality is differentially associated with specific domains of social vulnerability rather than overall vulnerability burden. Household composition and disability represent clinically salient risk factors, demonstrating the relevance of functional status and caregiving context in RA outcomes. Domain-specific assessment of social vulnerability may enhance clinical risk stratification and inform more targeted, patient-centered RA management.<\/jats:p>","DOI":"10.3390\/medsci14020314","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T05:59:47Z","timestamp":1781503187000},"page":"314","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["County-Level Association Between Social Vulnerability and Rheumatoid Arthritis-Related Mortality in the United States"],"prefix":"10.3390","volume":"14","author":[{"given":"Wan-Ying","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY 14260, USA"},{"name":"Department of Internal Medicine, Catholic Health System, Buffalo, NY 14214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8418-7228","authenticated-orcid":false,"given":"Yu-Che","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, University at Buffalo, Buffalo, NY 14260, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1646-122X","authenticated-orcid":false,"given":"Abira A.","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY 14260, USA"},{"name":"Department of Internal Medicine, Catholic Health System, Buffalo, NY 14214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M.","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY 14260, USA"},{"name":"Department of Internal Medicine, Catholic Health System, Buffalo, NY 14214, USA"},{"name":"Buffalo Rheumatology and Medicine, Buffalo, NY 14226, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5581-6793","authenticated-orcid":false,"given":"Hsin-Yao","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan"},{"name":"20\/20 Biolabs, Gaithersburg, MD 20877, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1093\/rheumatology\/kel253","article-title":"Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis","volume":"46","author":"Young","year":"2007","journal-title":"Rheumatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s11926-010-0117-y","article-title":"Epidemiology of rheumatoid arthritis: Rheumatoid arthritis and mortality","volume":"12","author":"Myasoedova","year":"2010","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1056\/NEJMra2103726","article-title":"Rheumatoid Arthritis\u2014Common Origins, Divergent Mechanisms","volume":"388","author":"Gravallese","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s13040-024-00389-7","article-title":"Identifying heterogeneous subgroups of systemic autoimmune diseases by applying a joint dimension reduction and clustering approach to immunomarkers","volume":"17","author":"Chang","year":"2024","journal-title":"BioData Min."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"321","DOI":"10.13107\/jocr.2025.v15.i12.6548","article-title":"Trends in Rheumatoid Arthritis Mortality in the United States, 1999\u20132020","volume":"15","author":"Shahzad","year":"2025","journal-title":"J. Orthop. Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1136\/annrheumdis-2013-204021","article-title":"Mortality in rheumatoid arthritis: The impact of disease activity, treatment with glucocorticoids, TNF\u03b1 inhibitors and rituximab","volume":"74","author":"Listing","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1136\/annrheumdis-2015-208579","article-title":"Anticitrullinated protein antibodies and rheumatoid factor are associated with increased mortality but with different causes of death in patients with rheumatoid arthritis: A longitudinal study in three European cohorts","volume":"75","author":"Ajeganova","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.semarthrit.2015.10.016","article-title":"Influence of demographic and clinical factors on the mortality rate of a rheumatoid arthritis cohort: A 20-year survival study","volume":"45","author":"Abasolo","year":"2016","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e006469","DOI":"10.1136\/bmjopen-2014-006469","article-title":"A novel measure of socioeconomic status using individual housing data to assess the association of SES with rheumatoid arthritis and its mortality: A population-based case-control study","volume":"5","author":"Ghawi","year":"2015","journal-title":"BMJ Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3603","DOI":"10.1007\/s10067-024-07148-3","article-title":"Functional disability and disease activity are affected by social determinants of health in patients with rheumatoid arthritis","volume":"43","author":"Movahedi","year":"2024","journal-title":"Clin. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1136\/annrheumdis-2014-206737","article-title":"Lower education and living in countries with lower wealth are associated with higher disease activity in rheumatoid arthritis: Results from the multinational COMORA study","volume":"75","author":"Putrik","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e2119400","DOI":"10.1001\/jamanetworkopen.2021.19400","article-title":"Socioeconomic Disparities in Functional Status in a National Sample of Patients With Rheumatoid Arthritis","volume":"4","author":"Izadi","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/fampra\/cmu059","article-title":"Combined effect of individual and neighbourhood socioeconomic status on mortality of rheumatoid arthritis patients under universal health care coverage system","volume":"32","author":"Chen","year":"2015","journal-title":"Fam. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1093\/rheumatology\/ket253","article-title":"Trajectories of functional limitation in early rheumatoid arthritis and their association with mortality","volume":"52","author":"Norton","year":"2013","journal-title":"Rheumatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/acr.25192","article-title":"Urban and Rural Patterns of Health Care Utilization Among People With Rheumatoid Arthritis and Osteoarthritis in a Large US Patient Registry","volume":"77","author":"Desilet","year":"2025","journal-title":"Arthritis Care Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1056\/NEJMsa1202099","article-title":"Mortality and Access to Care among Adults after State Medicaid Expansions","volume":"367","author":"Sommers","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1377\/hlthaff.2017.0293","article-title":"Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults","volume":"36","author":"Sommers","year":"2017","journal-title":"Health Aff."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1056\/NEJMsa1212321","article-title":"The Oregon Experiment\u2014Effects of Medicaid on Clinical Outcomes","volume":"368","author":"Baicker","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_19","unstructured":"GBD 2021 Rheumatoid Arthritis Collaborators (2023). Global, regional, and national burden of rheumatoid arthritis, 1990\u20132020, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol., 5, e594\u2013e610."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1097\/TA.0000000000003514","article-title":"Evaluating the complex association between Social Vulnerability Index and trauma mortality","volume":"92","author":"Neiman","year":"2022","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_21","unstructured":"Curtin, S.C., and Spencer, M.R. (2026, January 26). Trends in Death Rates in Urban and Rural Areas: United States, 1999\u20132019, Available online: https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db417.htm."},{"key":"ref_22","unstructured":"(2026, May 29). State-and-County-Level Social Vulnerability Index and Trends in Systemic Lupus Erythematosus-Related Mortality in the U.S. ACR Meeting Abstracts. Available online: https:\/\/acrabstracts.org\/abstract\/state-and-county-level-social-vulnerability-index-and-trends-in-systemic-lupus-erythematosus-related-mortality-in-the-u-s\/."},{"key":"ref_23","unstructured":"(2026, May 29). Demographic Risk Factors, Social Vulnerability Index, and Mortality in Patients with Systemic Lupus Erythematosus. ACR Meeting Abstracts. Available online: https:\/\/acrabstracts.org\/abstract\/demographic-risk-factors-social-vulnerability-index-and-mortality-in-patients-with-systemic-lupus-erythematosus\/."},{"key":"ref_24","unstructured":"(2026, May 29). Impact of Neighborhood-Level Social Vulnerability on Disease Severity, Clinical Manifestations, and Early Mortality in Systemic Lupus Erythematosus. ACR Meeting Abstracts. Available online: https:\/\/acrabstracts.org\/abstract\/impact-of-neighborhood-level-social-vulnerability-on-disease-severity-clinical-manifestations-and-early-mortality-in-systemic-lupus-erythematosus\/."},{"key":"ref_25","unstructured":"(2026, May 29). Social Vulnerability Associations with Mortality in a Lupus Cohort. ACR Meeting Abstracts. Available online: https:\/\/acrabstracts.org\/abstract\/social-vulnerability-associations-with-mortality-in-a-lupus-cohort\/."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Molina, E., del Rincon, I., Restrepo, J.F., Battafarano, D.F., and Escalante, A. (2015). Mortality in Rheumatoid Arthritis (RA): Factors associated with recording RA on death certificates. BMC Musculoskelet. Disord., 16.","DOI":"10.1186\/s12891-015-0727-7"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/314\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T02:15:59Z","timestamp":1781748959000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medsci14020314"],"URL":"https:\/\/doi.org\/10.3390\/medsci14020314","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}