Association of Rheumatoid Arthritis With Postfracture Mortality and Fracture-Related Care
Bibliographic record
Abstract
OBJECTIVE: Rheumatoid arthritis (RA) is a potentially devastating autoimmune disease associated with multiple comorbidities, including osteoporosis and cardiovascular disease, which exert significant morbidity and mortality burdens. Despite the recognized connection between RA and fracture risk, few studies have evaluated postfracture survival in RA, and no studies have evaluated the effect of RA on postfracture survival between 1990 and 2010, when there was a rapid growth in disease-modifying antirheumatic drug (DMARD) availability in combination with a paradigm shift in the understanding of RA. METHODS: We performed a case-control matched retrospective cohort study of 1304 patients with RA, using routinely collected administrative health data from public and private hospitals in Western Australia, to assess survival after a first fracture. RESULTS: We found that RA associated with a significant survival disadvantage after fracture (hazard ratio [HR] for death 1.28, 95% CI 1.18-1.39). In contrast to expectations, postfracture survival did not improve from 1990-1999 to 2000-2010 in patients with RA or in controls (HR: RA 0.95, 95% CI 0.75-1.20 vs controls 0.86, 95% CI 0.71-1.04). Further, we found that RA is a risk factor for increased episodes of hospital-based care (odds ratio 1.27, 95% CI 1.08-1.48). CONCLUSION: Using data from hospitals in Western Australia, this study demonstrates that people with RA have worse survival after fracture, and, in contrast to expectation, this survival has not improved despite significant therapeutic advances over the past 40 years. Consequently, this study emphasizes the need to better understand and treat fractures in RA to improve the lives of these patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".