Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis

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Abstract

Objectives

Osteoarthritis (OA) is a leading cause of disability, but the relationship with premature mortality remains uncertain. We aimed to investigate the relationship between OA and mortality from any cause and from cardiovascular disease (CVD).

Methods

Electronic literature databases searches were conducted to identify prospective studies comparing mortality in a sample of people with and without OA. Risk of all-cause and CVD mortality were summarized using adjusted hazard ratios (HRs) for joint specific (hand, hip, and knee) and joint non-specific OA. New data from the Progetto Veneto Anziani (PRO.V.A.) study were also included.

Results

From the PRO.V.A. study (N = 2927), there was no significant increase in mortality risk for participants with any joint OA (N = 1858) compared to non-OA (all-cause, HR = 0.95, 95% CI: 0.77–1.15 and CVD, HR = 1.12, 95% CI: 0.82–1.54). On meta-analysis, seven studies (OA = 10,018/non-OA = 18,541), with a median 12-year follow-up, reported no increased risk of any-cause mortality in those with OA (HR = 1.10, 95% CI: 0.97–1.25). After removing data on hand OA, a significant association between OA and mortality was observed (HR = 1.18, 95% CI: 1.08–1.28). There was a significant higher risk of overall mortality for (1) studies conducted in Europe, (2) patients with multi-joint OA; and (3) a radiological diagnosis of OA. OA was associated with significantly higher CVD mortality (HR = 1.21, 95% CI: 1.10–1.34).

Conclusions

People with OA are at increased risk of death due to CVD. The relationship with overall mortality is less clear and may be moderated by the presence of hand OA.

Section snippets

Overall cohort

Previously unpublished data from the Progetto Veneto Anziani (PRO.V.A. study) were used to investigate the risk of overall and CVD mortality in people with OA over a mean follow-up of 4.4 years. The Pro.V.A. study is an observational cohort study on the Italian population aged over 65 years. The study population initially included 3099 older Caucasian adults (1245 men/1854 women), who were randomly selected between 1995 and 1997 using a multistage stratified method, in two North Italian towns

Baseline characteristics

In the PRO.V.A. study, participants with OA (N = 1858; 63.5%) were significantly older, with a greater proportion of women compared to those without OA (n = 1069) (Table 1). Subjects with OA had also a significantly higher presence of potential risk factors for early mortality; including lower GNRI, preserved number of ADLs, and higher presence of depressive symptoms; frailty, osteoporotic fractures, orthostatic hypotension and hypertension, diabetes, and CVD, compared to the non-OA group (

Discussion

To the best of our knowledge, this is the first meta-analysis investigating the association between OA and mortality. The seven meta-analyzed studies (including 10,018 participants with and 18,541 people without OA) demonstrated that the presence of OA was not associated with mortality, although this appeared to substantially depend on between-study heterogeneity. When analyzing studies conducted in Europe, we observed a significantly higher risk of mortality and lower heterogeneity. A

Funding sources

The data collection phase of the PRO.V.A. study was supported by the Fondazione Cassa di Risparmio di Padova e Rovigo; the University of Padova (01/2014); the Azienda Unità Locale Socio Sanitaria 15 and 18 of the Veneto Region; and a grant from the Veneto Regional Authority (Ricerca Sanitaria Finalizzata no. 156/03). The data analysis phase was also financed by a grant from the University of Padova (Population aging—economics, health, retirement, and the welfare state—POPA_EHR). The funding

Acknowledgments

We would like to thank Dr. Marta Cecilia Castano Betancourt who gave some additional data about her article.

References (52)

  • Q. Liu et al.

    Knee osteoarthritis and all-cause mortality: the Wuchuan Osteoarthritis Study

    Osteoarthritis Cartilage

    (2015)
  • V.L. Johnson et al.

    The epidemiology of osteoarthritis

    Best Pract Res Clin Rheumatol

    (2014)
  • M.L. Capone et al.

    NSAIDs and cardiovascular disease: transducing human pharmacology results into clinical read-outs in the general population

    Pharmacol Rep

    (2010)
  • Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

    Lancet

    (2015)
  • M. Cross et al.

    The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study

    Ann Rheum Dis

    (2014)
  • A. Biswas et al.

    Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults

    Ann Intern Med

    (2015)
  • S. van der Pas et al.

    European project on osteoarthritis: design of a six-cohort study on the personal and societal burden of osteoarthritis in an older European population

    BMC Musculoskelet Disord

    (2013)
  • A.J. Hall et al.

    Association between osteoarthritis and cardiovascular disease: systematic review and meta-analysis

    Eur J Prev Cardiol

    (2015)
  • M.C. Hochberg

    Mortality in osteoarthritis

    Clin Exp Rheumatol

    (2008)
  • E. Nüesch et al.

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

    Br Med J

    (2011)
  • R. Liu et al.

    Mortality in osteoarthritis patients consulting health care

    Scand J Rheumatol

    (2015)
  • M.-C. Corti et al.

    The effect of cardiovascular and osteoarticular diseases on disability in older Italian men and women: rationale, design, and sample characteristics of the Progetto Veneto Anziani (PRO.V.A.) study

    J Am Geriatr Soc

    (2002)
  • N. Veronese et al.

    Serum 25-hydroxyvitamin D and osteoarthritis in older people: the progetto veneto anziani study

    Rejuvenation Res

    (2015)
  • American Autonomic Society and the American Academy of Neurology

    Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology

    Neurology

    (1996)
  • T.G. Pickering et al.

    Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on high blood pressure research

    Hypertension

    (2005)
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