Sex-, Race-Based Disparities Still Prevalent for CVD-Related Mortality in Arthritis

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An analysis of CDC WONDER data details disparities among the cardiovascular mortality rate for patients with rheumatoid arthritis in the US.

Despite declines in the early half of the 21st century, new research suggests cardiovascular mortality should remain a chief concern for many with rheumatoid arthritis (RA).

An analysis of the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) dataset from 1999 through 2020, results of the analysis demonstrate an overall decrease in age-adjusted mortality rates (AAMR) among patients with rheumatoid arthritis during the study period, but further analysis revealed concerning disparities for women and other race-based patient subgroups.

“From 1999 to 2020, [cardiovascular disease]-related mortality associated with RA has decreased in the US, indicating advancements in medical care,” wrote investigators.1 “Yet, despite this overall decline, substantial disparities endure, notably among non-Hispanic American Indian/Alaskan Native populations, females, residents of micropolitan areas, and those in the Midwestern regions, who exhibit significantly higher AAMRs.”

The culmination of decades worth of public health efforts, advancements in pathophysiology, and breakthroughs in pharmacological therapy, the progress made against cardiovascular disease on a population level is among the most significant victories in the history of healthcare. However, in the last 30 years, burgeoning rates of obesity, diabetes, and other risk factors have resulted in a plateauing of this progress. A thorough understanding of contributors, drivers of risk, and at-risk populations stands to have meaningful impact on care for patients, particularly those already at increased risk such as patients with RA.1,2

In the current study, a team led by Salman Zahid, MD, of the Department of Cardiovascular Medicine in the Knight Cardiovascular Institute at Oregon Health and Science University, sought to examine trends of RA associated cardiovascular disease-related mortality among US adults. With this in mind, investigators designed their study as a retrospective analysis of data collected within the CDC’s WONDER database from 1999 through 2020.1

The primary outcomes of interest for the analysis were AAMR per 100,000 persons and calculated the annual percentage change (APC), which were estimated through Joinpoint regression. Investigators pointed out prespecified plans to stratify outcomes according to sex, race, and geographic patterns. For inclusion in the study, patients needed to be 25 years of age or older and experience a death where RA and cardiovascular disease played a primary or contributive role.1

Initial analysis revealed 73% of the deaths occurred in females, with the greatest proportion of deaths recorded among non-Hispanic White adults (83.8%), followed by non-Hispanic Black (7.92%), Hispanic or Latino (5.58%), non-Hispanic Asian or Pacific Islanders (1.68%) and non-Hispanic American Indians or Alaska Natives (0.86%).1

The study’s primary outcome analysis indicated overall AAMR decreased from 3.50 per 100,000 in 1999 to 2.79 per 100,000 in 2020, but investigators pointed out females consistently experiencing a higher AAMR (3.35 per 100,000) compared to males (1.74 per 100,000).Further analysis according to race revealed the greatest AAMR was observed among non-Hispanic American Indian/Alaska Native patients (4.44 per 100,000), followed by non-Hispanic White patients (2.83 per 100,000), non-Hispanic Black or African American patients (2.47 per 100,000), and Hispanic or Latino patients (2.13 per 100,000). In contrast, the lowest AAMR was seen among non-Hispanic Asian/Pacific Islander patients (1.28).1

Assessment of AAMR according to geographic region suggested the lowest AAMR was observed in the Northeast (2.19 per 100,000) and large metropolitan areas (2.28 per 100,000), with greater AAMRs observed in the Midwestern region (3.12), micropolitan areas (3.47), and nonmetropolitan areas (3.37). Investigators highlighted the greatest AAMRs among individual states were observed for those in North Dakota, South Dakota, Vermont, Minnesota, and Wyoming.1

“Redressing these disparities necessitates the implementation of targeted population level interventions,” investigators added.1


  1. Ahmad M, Shehzad D, Shehzad M, et al. Trends in rheumatoid arthritis associated cardiovascular mortality in the United States from 1999 to 2020. Curr Probl Cardiol. 2024;49(7):102607. doi:10.1016/j.cpcardiol.2024.102607
  2. Campbell P. Experts’ perspectives: Top issue facing cardiology in 2024. HCP Live. February 24, 2024. Accessed June 11, 2024.