Knee osteoarthritis and time-to all-cause mortality in six community-based cohorts: an international meta-analysis of individual participant-level data.
Knee
Meta-analysis
Mortality
Osteoarthritis
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
02
11
2020
accepted:
21
11
2020
pubmed:
17
2
2021
medline:
12
3
2021
entrez:
16
2
2021
Statut:
ppublish
Résumé
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. 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. 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. 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. Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.
Sections du résumé
BACKGROUND
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
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
RESULTS
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
CONCLUSIONS
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.
FUNDING
BACKGROUND
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.
Identifiants
pubmed: 33590469
doi: 10.1007/s40520-020-01762-2
pii: 10.1007/s40520-020-01762-2
pmc: PMC7943431
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
529-545Subventions
Organisme : Versus Arthritis
ID : 21595
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12011/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UP_A620_1014
Pays : United Kingdom
Organisme : Versus Arthritis
ID : 17702
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0400491
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_U147585819
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_21000
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_U147585827
Pays : United Kingdom
Organisme : NIAMS NIH HHS
ID : P30 AR072571
Pays : United States
Organisme : Medical Research Council
ID : MC_U147585824
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_PC_21001
Pays : United Kingdom
Investigateurs
Lyn March
(L)
Gillian Hawker
(G)
Philip Conaghan
(P)
Virginia Byers Kraus
(VB)
Ali Guermazi
(A)
David Hunter
(D)
Jeffrey N Katz
(JN)
Tim McAlindon
(T)
Tuhina Neogi
(T)
Lee Simon
(L)
Marita Cross
(M)
Lauren King
(L)
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