The impact of painful knee osteoarthritis on mortality: a community-based cohort study with over 24 years of follow-up. Issue 4 (April 2019)

• Record Type: Journal Article
• Authors: Cleveland, R.J.; Alvarez, C.; Schwartz, T.A.; Losina, E.; Renner, J.B.; Jordan, J.M.; Callahan, L.F.
• Is Part Of: Osteoarthritis and cartilage. Volume 27:Issue 4(2019)
• Page Start: 593
• Page End: 602
• Publication Date: 2019-04
• Subjects: Knee osteoarthritis -- Joint pain -- Mortality -- Epidemiology; AA African Americans -- BMI body mass index -- CDC Centers for Disease Control and Prevention -- CESD Center for Epidemiologic Studies Depression -- CI confidence intervals -- CVD cardiovascular disease -- FCS fully conditional specification methods -- HR hazard ratios -- ICD International Classification of Diseases -- JoCoOA Johnston County Osteoarthritis Project -- KL Kellgren–Lawrence -- MAR missing-at-random -- MI multiple imputation -- MVPA moderate/vigorous physical activity -- NDI National Death Index -- NSAIDS non-steroidal anti-inflammatory drugs -- OA Osteoarthritis -- PROMIS-D Patient Reported Outcomes Measurement Information System Depression -- rOA radiographic OA -- SD standard deviation -- SxOA symptomatic OA -- TVC time-varying covariates; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Osteoarthritis -- Periodicals; Cartilage -- Periodicals; Arthrose -- Périodiques; Articulations -- Maladies -- Périodiques; 616.7223005
• DOI: 10.1016/j.joca.2018.12.008
• Languages: English
• ISSNs: 1063-4584

Abstract

Summary: Objective: To investigate the impact of knee osteoarthritis (OA) and/or knee pain on excess mortality. Method: We analyzed data from 4, 182 participants in a community-based prospective cohort study of African American and Caucasian men and women aged ≥45 years. Participants completed knee radiographs and questionnaires at baseline and at up to three follow-ups to determine knee OA (rOA), knee pain and covariate status. Mortality was determined through 2015. We used Cox proportional hazards regression with time-varying covariates (TVC) to estimate hazard ratios (HR) and 95% confidence intervals (CI). Additional analyses stratified by sex, race and age were carried out. Results: Median follow-up time was 14.6 years during which 1822 deaths occurred. Baseline knee radiographic osteoarthritis (rOA) was 27.7%, 38.8% at first follow-up, 52.6% at second follow-up and 61.9% at the third follow-up. Knee rOA with pain and knee pain alone were both associated with a >15% increase in premature all-cause mortality. In analyses stratified by sex, race and age, associations between knee pain, with or without knee rOA, and all-cause death were found among women, Caucasians, those ≤65 years of age, and those with a body mass index (BMI)≥30, with observed increased risks of death between 21% and 65%. We observed similar, somewhat attenuated, results for cardiovascular disease (CVD) deaths. Conclusion: In models taking into account variables that change over time, individuals who had knee pain, alone or with knee rOA, had increased mortality. These effects were particularly strong among those obese. Effective interventions to reduce knee pain, particularly those including weight management and prevention of comorbidities, could reduce mortality.