Showing papers by "James F. Fries published in 2016"

Prednisone Use and Risk of Mortality in Patients With Rheumatoid Arthritis: Moderation by Use of Disease-Modifying Antirheumatic Drugs.

Abstract: Objective Medications for rheumatoid arthritis (RA) may affect survival. However, studies often include limited followup and do not account for selection bias in treatment allocation. Using a large longitudinal database, we examined the association between prednisone use and mortality in RA, and whether this risk was modified with concomitant disease-modifying antirheumatic drug (DMARD) use, after controlling for propensity for treatment with prednisone and individual DMARDs. Methods In a prospective study of 5,626 patients with RA followed for up to 25 years, we determined the risk of death associated with prednisone use alone and combined treatment of prednisone with methotrexate (MTX) or sulfasalazine. We used the random forests method to generate propensity scores for prednisone use and each DMARD at study entry and during followup. Mortality risks were estimated using multivariate Cox models that included propensity scores. Results During followup (median 4.97 years), 666 patients (11.8%) died. In a multivariate, propensity-adjusted model, prednisone use was associated with an increased risk of death (hazard ratio [HR] 2.83 [95% confidence interval (95% CI) 1.03–7.76]). However, there was a significant interaction between prednisone use and MTX use (P = 0.03), so that risk was attenuated when patients were treated with both medications (HR 0.99 [95% CI 0.18–5.36]). However, combination treatment also weakened the protective association of MTX with mortality. Results were similar for sulfasalazine. Conclusion Prednisone use was associated with a significantly increased risk of mortality in patients with RA. This association was mitigated by concomitant DMARD use, but combined treatment also negated the previously reported beneficial association of MTX with survival in RA.

On the Compression of Morbidity: From 1980 to 2015 and Beyond

Abstract: The Compression of Morbidity phenomenon occurs when, for individual, cohort, or society, the age at onset of morbidity (disability) is postponed to a greater degree than is the age of mortality (death), thus compressing the progressive disability of later life into a shorter period of time. Compression of Morbidity has been documented at the societal level in some instances but Expansion of Morbidity, the reverse phenomenon, has been documented in other settings. Compression of Morbidity has been demonstrated most definitively in longitudinal studies over up to a quarter century. Here, cohorts were initially selected, using baseline information, to have a higher or lower probability of lifelong adherence to preventive behaviors such as maintaining exercise, normal weight, and tobacco abstinence. Two such studies, the longest and the most recent, are described in this chapter. Study of a high physical exercise cohort compared with community controls over more than 20 years showed that disability at age 80 years had been postponed by nearly 16 years while mortality had been postponed about 7 years in the exercise cohort as opposed to controls. A similar study compared three groups of university alumni divided at baseline into cohorts with zero, one, or two/three major risk factors out of exercise, weight, and tobacco use and followed from age 69 to almost 90 years of age. The zero initial risk factor cohort postponed morbidity by 10 years and mortality by 3.3 years compared to high risk. The differences increased over time, occurred in all subgroups, and persisted after statistical adjustment. These differences, and the broader literature on these risk factors and long-term health outcomes, suggest a major effect of good health habits maintained for a lifetime upon future health. We suspect that preventive behaviors established early in life, before aging processes are evident, have advantages over interventions begun later, in large part because of increasing problems from competing risks when the subject population is older.