Rheumatoid Arthritis Mortality Declines Among US Postmenopausal Women
Key Clinical Summary
- Age-adjusted rheumatoid arthritis (RA) mortality among US women aged ≥ 55 years declined 56% from 1999 to 2023 (average annual percentage change [AAPC] −3.53), despite a temporary COVID-19–related spike.
- Non-Hispanic White women, residents of the Midwest and West, and women aged ≥85 years had the highest mortality rates.
- Forecasting models project continued declines through 2030, with age-adjusted mortality rates (AAMRs) expected to reach 1.55 per 100 000.
RA mortality among postmenopausal women in the US has declined substantially over the past 2 decades, according to an analysis of Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data from 1999 to 2023. The study evaluated national and subgroup trends, including racial, regional, and age-based disparities, and projected mortality rates through 2030.
Study Findings
Between 1999 and 2023, 42 497 RA-related deaths were recorded among US women aged 55 years and older, a proxy for postmenopausal status. Age-adjusted mortality rates fell from 5.75 (95% CI, 5.49-6.00) per 100 000 in 1999 to 2.51 (95% CI, 2.37-2.64) in 2023, representing an average annual percentage change (AAPC) of −3.53 (95% CI, −3.88 to −3.17).
A temporary increase occurred between 2019 and 2020 during the COVID-19 pandemic. RA-related deaths rose from 1,388 in 2019 to 1428 in 2020. Of the 2020 deaths, 1005 (70.4%) involved COVID-19 as an underlying or contributing cause, suggesting disproportionate pandemic-related vulnerability among patients with RA.
Racial and ethnic disparities persisted. Non-Hispanic White women consistently experienced the highest AAMRs, declining from 6.02 in 1999 to 2.55 in 2023 (AAPC −3.56). Hispanic or Latino women had the second-highest rates, followed by non-Hispanic Black and non-Hispanic Other groups. Notably, Hispanic women did not exhibit a clear pandemic-related mortality spike.
Regionally, the Midwest and West reported the highest AAMRs, while the Northeast had the lowest. Western states saw a 17.52% increase in AAMR from 2019 to 2020, followed by a 16.19% decline from 2020 to 2021. Women aged ≥85 years consistently had the highest mortality, although all age groups experienced long-term declines.
Using autoregressive integrated moving average modeling, investigators projected that annual RA deaths will decline to approximately 1116 by 2030, with AAMRs falling to 1.55 per 100 000.
Clinical Implications
For managed care organizations and payers, the sustained reduction in RA-related mortality likely reflects advances in early diagnosis, multidisciplinary management, and broader access to disease-modifying antirheumatic drugs (DMARDs) and biologic therapies. These improvements align with American College of Rheumatology recommendations for early, intensive treatment.
However, persistent disparities underscore structural inequities in risk and outcomes. Higher mortality among non-Hispanic White women may relate to genetic susceptibility and environmental co-exposures, including particulate matter linked to pulmonary and cardiovascular complications. Hispanic populations face additional barriers, including treatment nonadherence, delayed referrals, and socioeconomic disadvantage.
Geographic variation suggests that regional health care access, environmental triggers, and sociodemographic development influence outcomes. The pronounced vulnerability among women aged ≥85 years highlights the compounded impact of immunosenescence, multimorbidity, and treatment-related adverse effects in elderly patients.
Targeted interventions—such as improving timely access to rheumatology care, optimizing DMARD utilization, and addressing environmental and social determinants of health—remain essential to reduce inequities.
The investigators said, “Overall, our findings reveal persistent RA mortality disparities across racial/ethnic, regional, and age groups, underscoring the urgent need for targeted, actionable interventions to promote equitable rheumatologic care.”
They further observed that pandemic-related disruptions disproportionately affected patients with RA, particularly those receiving immunosuppressive therapy.
Conclusion
Although RA mortality among US postmenopausal women has fallen markedly since 1999, disparities by race, region, and age persist. Continued progress through 2030 will depend on equitable access to evidence-based care and resilience against future healthcare disruptions.
Reference
Zhao Y, Cui W, Han Y, Qiao J, Chang M. Trends in rheumatoid arthritis mortality among postmenopausal women in the United States, 1999–2023. iMetaMed. 2025:1-5. doi:https://doi.org/10.1002/imm3.70024
