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146690 - knee osteoarthritis and time to all cause mortality.pdf (1.31 MB)

Knee osteoarthritis and time-to all-cause mortality in six community-based cohorts: an international meta-analysis of individual participant-level data

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journal contribution
posted on 2023-05-21, 02:35 authored by Leyland, KM, Gates, LS, Sanchez-Santos, MT, Nevitt, MC, Felson, D, Graeme JonesGraeme Jones, Jordan, JM, Judge, A, Prieto-Alhambra, D, Yoshimura, N, Newton, JL, Callahan, LF, Cooper, C, Batt, ME, Lin, J, Liu, Q, Cleveland, RJ, Collins, GS, Arden, NK, March, L, Hawker, G, Conaghan, P, Kraus, VB, Guermazi, A, Hunter, D, Katz, JN, McAlindon, T, Neogi, T, Simon, L, Cross, M, King, L

Background: Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population.

Methods: Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung-Knapp modification for random-effects meta-analysis.

Findings: 10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA.

Discussion: Participants with POA or PROA had a 35-37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality.


Publication title

Aging Clinical and Experimental Research








Menzies Institute for Medical Research



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Copyright 2021 the authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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Human pain management

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