Association between anemia and mortality in patients with rheumatoid arthritis: A retrospective cohort study of the National Health and nutrition examination survey (NHANES) database

Prev Med Rep. 2025 Apr 12;54:103068. doi: 10.1016/j.pmedr.2025.103068. eCollection 2025 Jun.

ABSTRACT

OBJECTIVES: This study aimed to investigate the impact of anemia on all-cause and cardiovascular disease (CVD) mortality in patients with rheumatoid arthritis.

METHODS: Data on patients with rheumatoid arthritis were extracted from the National Health and Nutrition Examination Survey (NHANES) dataset from 1999 to 2006 and 2017-2018. The associations of total anemia, ferritin, iron deficiency anemia, non‑iron deficiency anemia, and transferrin saturation with all-cause and CVD mortality were evaluated using a weighted multivariable Cox regression model, with hazard ratios (HRs) and 95 % confidence intervals (CIs) calculated.

RESULTS: Among the 848 patients included, 495 (62.09 %) survived, 353 (37.91 %) died, and 135 (13.79 %) died from CVD. Total anemia (HR = 1.64, 95 %CI: 1.13-2.39) and iron deficiency anemia (HR = 2.02, 95 %CI: 1.37-2.96) were Aassociated with an increased risk of all-cause mortality, whereas total anemia (HR = 1.76, 95 %CI: 1.02-3.04) and non‑iron deficiency anemia (HR = 2.07, 95 %CI: 1.02-4.18) were associated with a higher risk of CVD mortality. No significant associations were found between ferritin and transferrin saturation and mortality in patients with rheumatoid arthritis (P > 0.05).

CONCLUSION: Iron deficiency anemia was associated with an increased risk of all-cause mortality in patients with rheumatoid arthritis, while non‑iron deficiency anemia was associated with CVD mortality.

PMID:40336599 | PMC:PMC12056958 | DOI:10.1016/j.pmedr.2025.103068