Does social disadvantage contribute to the excess mortality in rheumatoid arthritis patients?

Background-Socioeconomic deprivation is associated with increased mortality from cardiovascular causes and malignancy. The influence of disadvantage i n patients with rheumatoid arthritis (RA), who are known to have premature mortality, has not been ascertained. Aim-To assess the relation between the level of patient deprivation and mor tality in RA patients. Methods-200 RA patients, enrolled in a study comparing sulfasalazine and pe nicillamine in 1984-85, have been followed up prospectively for 12 years. S ubjects were categorised into Carstairs groups with deprivation scores rang ing from 1 (most affluent) to 7 (most deprived). Information about deaths w as obtained from the Registrar General in Scotland, death certificates and GP/hospital records. Results-There were more RA patients in the deprived areas then expected com pared with the West of Scotland and England and Wales. Some 47.5% of the RA patients had died by 12 years-the majority of cardiorespiratory causes or malignancy. There were no differences in the median age or disease duration in the various Carstairs groups at study entry, but the percentage of deat hs was higher in the more deprived groups after 12 years (36% dead in most affluent area compared with 61% in the most deprived, that is, in groups 6 and 7). Conclusion-In patients with RA increasing deprivation was associated with p remature mortality. If confirmed elsewhere these findings have implications for rheumatological management strategies, for researchers involved in col laborative studies of patients from different socioeconomic backgrounds and for resource allocation.