{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T17:56:52Z","timestamp":1794333412944,"version":"4.9.0"},"reference-count":29,"publisher":"The Journal of Rheumatology","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To evaluate rheumatoid arthritis (RA)\u2013related mortality in the state of S\u00e3o Paulo (Brazil).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Data from all death certificates (DC) from 1996 to 2010 were analyzed using a multiple cause-of-death method. We compared the results from 2 subperiods (1996\u20132000 and 2006\u20132010).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>We found 3955 DC related to RA \u2014 27.6% with RA as the underlying cause of death (UCD) and 72.4% with RA as the nonunderlying cause of death (NUCD). Ninety percent of RA-related deaths occurred at age \u2265 50 years. The mean ages at death were 67.1 \u00b1 13.3 and 67.9 \u00b1 13 years for RA as the UCD and NUCD, respectively. The most frequent NUCD associated with RA were pneumonia, sepsis, renal failure, interstitial lung disease, and heart failure. In the last subperiod, there was an increase in infectious causes. When RA was an NUCD, we observed a decrease in the mean age at death for the last subperiod (p = 0.021). The most common UCD were circulatory and respiratory system diseases. Comparing the mean age at death between RA-related deaths and the general population when deaths occurred at ages beyond 50 years, the linear regression analysis showed a downward curve for RA-related death (p &lt; 0.001 and r = \u22120.795), while for the general population, as expected, the curve had an upward pattern (p &lt; 0.001 and r = 0.993).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>Unexpectedly, RA-related deaths occurred at earlier ages in the more recent subperiod. Cardiovascular disease remained the most important cause, and infectious diseases are an increasing cause of death associated with RA, raising the question of whether infections were related to the more vigorous immunosuppressive treatment recommended by recent guidelines.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.150166","type":"journal-article","created":{"date-parts":[[2015,10,16]],"date-time":"2015-10-16T01:48:17Z","timestamp":1444960097000},"page":"2221-2228","source":"Crossref","is-referenced-by-count":56,"title":["A Study of Multiple Causes of Death in Rheumatoid Arthritis"],"prefix":"10.3899","volume":"42","author":[{"given":"Frederico A.G.","family":"Pinheiro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah C.C.","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia I.","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2015,10,15]]},"reference":[{"key":"2018112909350718000_42.12.2221.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60826-4"},{"key":"2018112909350718000_42.12.2221.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-857X(05)70201-5"},{"key":"2018112909350718000_42.12.2221.3","first-page":"594","article-title":"Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach","volume":"31","author":"Senna","year":"2004","journal-title":"J Rheumatol"},{"key":"2018112909350718000_42.12.2221.4","first-page":"169","article-title":"[Multicenter study of the prevalence of rheumatoid arthritis in adult samples of the Brazilian population]","volume":"33","author":"Marques-Neto","year":"1993","journal-title":"Rev Bras Reumatol"},{"issue":"Suppl 51","key":"2018112909350718000_42.12.2221.5","first-page":"S35","article-title":"Mortality in rheumatoid arthritis: 2008 update","volume":"26","author":"Sokka","year":"2008","journal-title":"Clin Exp Rheumatol"},{"key":"2018112909350718000_42.12.2221.6","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110241"},{"key":"2018112909350718000_42.12.2221.7","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-597"},{"key":"2018112909350718000_42.12.2221.8","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/oxfordjournals.aje.a114375","article-title":"Analytical potential for multiple cause-of-death data","volume":"124","author":"Israel","year":"1986","journal-title":"Am J Epidemiol"},{"key":"2018112909350718000_42.12.2221.9","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/23.3.545"},{"key":"2018112909350718000_42.12.2221.10","unstructured":"[Brazilian Institute of Geography and Statistics - Synthesis of S\u00e3o Paulo State]. 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