Global mortality trends of inflammatory rheumatic diseases between 2000 and 2019

Background

Previous global estimates of Inflammatory Rheumatic Diseases (IRD) mortality only extend to 2014 and focus on few conditions, omitting prevalent diseases such as gout and spondyloarthritis. We assessed global mortality trends of gout, rheumatoid arthritis (RA), spondyloarthritis (SpA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) in 2000-2019.

Methods

We used the open access WHO mortality database to evaluate global temporal trends of five IRDs in countries with data usability ≥60%—a measure of data quality. Age-and-sex-standardised mortality rate (as-SMR) with 95% confidence intervals (95%CI) were computed. Annual percentage changes (APCs) of as-SMRs rates were estimated using generalised additive models stratified by age, sex, geographical area, and income category.

Results

63 countries were included. Globally, gout mortality significantly increased, while RA and SpA mortality significantly declined and SLE and SSc showed modest significant increases. Gout mortality rose sharply in lower-middle income (LMI) countries (APC +5·45% [+3·61%, +7·34%]) but remained stable in high-income (HI) settings. RA mortality declined in HI countries (–2·24% [–2·63%, –1·85%]) but increased in upper-middle income (UMI) countries (+1·57% [+0·48%, +2·67%]). SpA mortality decreased in HI countries but showed no significant change elsewhere. SLE mortality declined in HI countries (–1·16% [–1·40%, –0·92%]) but increased in UMI (+1·53% [+1·16%, +1·89%]) and LMI countries (+2·86% [+2·24%, +3·48%]). Similarly, SSc mortality decreased in HI countries (–0·40% [–0·57%, –0·22%]), increased in UMI countries (+2·20% [+1·57%, +2·84%]), and remained unchanged in LMI settings.

Conclusions

Improvements in IRD mortality were largely confined to high-income countries, while stable or worsening trends predominated in resource-limited settings, indicating widening global health inequalities and the unmet need to improve equitable access to treatments preventing mortality.

Key messages

• This study underscores that inflammatory rheumatic diseases (IRDs) mortality is an unmet global health equity challenge.

• There is a critical need for development of targeted strategies that can improve outcomes in a resource limited setting.