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All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study.

Nüesch E, Dieppe P, Reichenbach S, Williams S, Iff S, Jüni P - BMJ (2011)

Bottom Line: Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70).Patients with osteoarthritis are at higher risk of death compared with the general population.Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.

View Article: PubMed Central - PubMed

Affiliation: Institute of Social and Preventive Medicine, University of Bern, Switzerland.

ABSTRACT

Objective: To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip.

Design: Population based cohort study.

Setting: General practices in the southwest of England.

Participants: 1163 patients aged 35 years or over with symptoms and radiological confirmation of osteoarthritis of the knee or hip.

Main outcome measures: Age and sex standardised mortality ratios and multivariable hazard ratios of death after a median of 14 years' follow-up.

Results: Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70). Excess mortality was observed for all disease specific causes of death but was particularly pronounced for cardiovascular (standardised mortality ratio 1.71, 1.49 to 1.98) and dementia associated mortality (1.99, 1.22 to 3.25). Mortality increased with increasing age (P for trend <0.001), male sex (adjusted hazard ratio 1.59, 1.30 to 1.96), self reported history of diabetes (1.95, 1.31 to 2.90), cancer (2.28, 1.50 to 3.47), cardiovascular disease (1.38, 1.12 to 1.71), and walking disability (1.48, 1.17 to 1.86). However, little evidence existed for increased mortality associated with previous joint replacement, obesity, depression, chronic inflammatory disease, eye disease, or presence of pain at baseline. The more severe the walking disability, the higher was the risk of death (P for trend <0.001).

Conclusion: Patients with osteoarthritis are at higher risk of death compared with the general population. History of diabetes, cancer, or cardiovascular disease and the presence of walking disability are major risk factors. Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.

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Fig 3 All cause and disease specific mortality in patients with and without walking disability at baseline examination. Kaplan-Meier curves show the cumulative incidence of all cause mortality, death from cardiovascular causes, cancer related death, death from respiratory causes, death from gastrointestinal causes, and death associated with dementia up to 15 years
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fig3: Fig 3 All cause and disease specific mortality in patients with and without walking disability at baseline examination. Kaplan-Meier curves show the cumulative incidence of all cause mortality, death from cardiovascular causes, cancer related death, death from respiratory causes, death from gastrointestinal causes, and death associated with dementia up to 15 years

Mentions: Figure 3 (top left) shows the cumulative incidence of death from all causes in patients with and without walking disability at baseline: 53% of patients with walking disability compared with 33% of patients without disability died. As indicated in table 3, the crude hazard ratio of 1.93 (1.59 to 2.36; P<0.001) was attenuated to 1.58 (1.29 to 1.93) after adjustment for age and sex and to 1.48 after full adjustment as reported above. In a sensitivity analysis, the 88 patients with severe walking disability had a higher risk of death from any cause (fully adjusted hazard ratio 1.88, 1.37 to 2.56) than did the 200 patients with moderate walking disability (1.31, 1.00 to 1.70; P for trend <0.001). Figure 3 shows that deaths from cardiovascular causes were higher in patients with walking disability (25% v 12%; crude hazard ratio 2.40, 1.79 to 3.23; P<0.001). Table 3 indicates that the association between deaths from cardiovascular causes and walking disability remained after adjustment for baseline covariates, although it was attenuated (fully adjusted hazard ratio 1.72, 1.22 to 2.41; P=0.002). Patients with walking disability also had higher rates of deaths from respiratory causes (4.9% v 3.4%, fully adjusted hazard ratio 1.74, 0.82 to 3.71; P=0.15) and gastrointestinal causes (3.5% v 1.3%; 2.51, 0.89 to 7.14; P=0.08) compared with patients without disability, but confidence intervals were wide and P values non-significant. Rates for cancer related death (11% v 11%; P=0.93) and death associated with dementia (1.4% v 1.6%; P=0.58) were similar between patients with and without walking disability at baseline examination.


All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study.

Nüesch E, Dieppe P, Reichenbach S, Williams S, Iff S, Jüni P - BMJ (2011)

Fig 3 All cause and disease specific mortality in patients with and without walking disability at baseline examination. Kaplan-Meier curves show the cumulative incidence of all cause mortality, death from cardiovascular causes, cancer related death, death from respiratory causes, death from gastrointestinal causes, and death associated with dementia up to 15 years
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3050438&req=5

fig3: Fig 3 All cause and disease specific mortality in patients with and without walking disability at baseline examination. Kaplan-Meier curves show the cumulative incidence of all cause mortality, death from cardiovascular causes, cancer related death, death from respiratory causes, death from gastrointestinal causes, and death associated with dementia up to 15 years
Mentions: Figure 3 (top left) shows the cumulative incidence of death from all causes in patients with and without walking disability at baseline: 53% of patients with walking disability compared with 33% of patients without disability died. As indicated in table 3, the crude hazard ratio of 1.93 (1.59 to 2.36; P<0.001) was attenuated to 1.58 (1.29 to 1.93) after adjustment for age and sex and to 1.48 after full adjustment as reported above. In a sensitivity analysis, the 88 patients with severe walking disability had a higher risk of death from any cause (fully adjusted hazard ratio 1.88, 1.37 to 2.56) than did the 200 patients with moderate walking disability (1.31, 1.00 to 1.70; P for trend <0.001). Figure 3 shows that deaths from cardiovascular causes were higher in patients with walking disability (25% v 12%; crude hazard ratio 2.40, 1.79 to 3.23; P<0.001). Table 3 indicates that the association between deaths from cardiovascular causes and walking disability remained after adjustment for baseline covariates, although it was attenuated (fully adjusted hazard ratio 1.72, 1.22 to 2.41; P=0.002). Patients with walking disability also had higher rates of deaths from respiratory causes (4.9% v 3.4%, fully adjusted hazard ratio 1.74, 0.82 to 3.71; P=0.15) and gastrointestinal causes (3.5% v 1.3%; 2.51, 0.89 to 7.14; P=0.08) compared with patients without disability, but confidence intervals were wide and P values non-significant. Rates for cancer related death (11% v 11%; P=0.93) and death associated with dementia (1.4% v 1.6%; P=0.58) were similar between patients with and without walking disability at baseline examination.

Bottom Line: Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70).Patients with osteoarthritis are at higher risk of death compared with the general population.Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.

View Article: PubMed Central - PubMed

Affiliation: Institute of Social and Preventive Medicine, University of Bern, Switzerland.

ABSTRACT

Objective: To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip.

Design: Population based cohort study.

Setting: General practices in the southwest of England.

Participants: 1163 patients aged 35 years or over with symptoms and radiological confirmation of osteoarthritis of the knee or hip.

Main outcome measures: Age and sex standardised mortality ratios and multivariable hazard ratios of death after a median of 14 years' follow-up.

Results: Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70). Excess mortality was observed for all disease specific causes of death but was particularly pronounced for cardiovascular (standardised mortality ratio 1.71, 1.49 to 1.98) and dementia associated mortality (1.99, 1.22 to 3.25). Mortality increased with increasing age (P for trend <0.001), male sex (adjusted hazard ratio 1.59, 1.30 to 1.96), self reported history of diabetes (1.95, 1.31 to 2.90), cancer (2.28, 1.50 to 3.47), cardiovascular disease (1.38, 1.12 to 1.71), and walking disability (1.48, 1.17 to 1.86). However, little evidence existed for increased mortality associated with previous joint replacement, obesity, depression, chronic inflammatory disease, eye disease, or presence of pain at baseline. The more severe the walking disability, the higher was the risk of death (P for trend <0.001).

Conclusion: Patients with osteoarthritis are at higher risk of death compared with the general population. History of diabetes, cancer, or cardiovascular disease and the presence of walking disability are major risk factors. Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.

Show MeSH
Related in: MedlinePlus