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All-cause mortality in knee and hip osteoarthritis and rheumatoid arthritis

Turkiewicz, Aleksandra LU ; Neogi, Tuhina; Björk, Jonas LU ; Peat, George and Englund, Martin LU (2016) In Epidemiology
Abstract

BACKGROUND:: While increased mortality in rheumatoid arthritis (RA) is well established there is conflicting evidence on the association between osteoarthritis (OA) and mortality. Our aim was to estimate all-cause mortality in Swedish patients with RA and OA compared with the general population. METHODS:: Cohort study of the population of Skåne region, Sweden (1.3 million), based on physicians’ diagnostic codes in a mandatory register covering all healthcare. We included all subjects aged ≥45 years who between 1998 and 2012 consulted any physician at least once. We identified those who received a diagnosis of RA, knee OA or hip OA. We followed all subjects until death, relocation outside Skåne region, or end of 2013, and analyzed data... (More)

BACKGROUND:: While increased mortality in rheumatoid arthritis (RA) is well established there is conflicting evidence on the association between osteoarthritis (OA) and mortality. Our aim was to estimate all-cause mortality in Swedish patients with RA and OA compared with the general population. METHODS:: Cohort study of the population of Skåne region, Sweden (1.3 million), based on physicians’ diagnostic codes in a mandatory register covering all healthcare. We included all subjects aged ≥45 years who between 1998 and 2012 consulted any physician at least once. We identified those who received a diagnosis of RA, knee OA or hip OA. We followed all subjects until death, relocation outside Skåne region, or end of 2013, and analyzed data using Cox proportional hazard regression with attained age as time scale. RESULTS:: We identified 8067 patients with RA, 51939 with knee OA and 29442 with hip OA among 524136 in the population aged ≥45 years. The mortality rates adjusted for sex, socioeconomic status and comorbidities were elevated for RA, hazard ratio 1.86 (95% confidence interval 1.78,1.94) but not in knee or hip OA compared with the general population seeking healthcare, hazard ratio 0.87 (0.85,0.89) and 0.90 (0.87,0.92), respectively. Extensive sensitivity analyses supported the conclusion of no increased mortality in OA. CONCLUSIONS:: In Sweden, RA is associated with about doubled mortality rate, but we found no increased mortality in patients with knee and hip OA. Possible selection of those seeking physician care for knee or hip pain and/or OA management in healthcare are plausible explanations.

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author
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
osteoarthritis, Rheumatoid Arthritis, knee and hip arthroplasty
in
Epidemiology
publisher
Wolters Kluwer Health/LWW
external identifiers
  • Scopus:84961223519
ISSN
1044-3983
DOI
10.1097/EDE.0000000000000477
language
English
LU publication?
yes
id
98a5afb6-52fb-4ad8-86c1-7b6c050db405
date added to LUP
2016-05-18 17:05:48
date last changed
2016-10-13 05:08:56
@misc{98a5afb6-52fb-4ad8-86c1-7b6c050db405,
  abstract     = {<p>BACKGROUND:: While increased mortality in rheumatoid arthritis (RA) is well established there is conflicting evidence on the association between osteoarthritis (OA) and mortality. Our aim was to estimate all-cause mortality in Swedish patients with RA and OA compared with the general population. METHODS:: Cohort study of the population of Skåne region, Sweden (1.3 million), based on physicians’ diagnostic codes in a mandatory register covering all healthcare. We included all subjects aged ≥45 years who between 1998 and 2012 consulted any physician at least once. We identified those who received a diagnosis of RA, knee OA or hip OA. We followed all subjects until death, relocation outside Skåne region, or end of 2013, and analyzed data using Cox proportional hazard regression with attained age as time scale. RESULTS:: We identified 8067 patients with RA, 51939 with knee OA and 29442 with hip OA among 524136 in the population aged ≥45 years. The mortality rates adjusted for sex, socioeconomic status and comorbidities were elevated for RA, hazard ratio 1.86 (95% confidence interval 1.78,1.94) but not in knee or hip OA compared with the general population seeking healthcare, hazard ratio 0.87 (0.85,0.89) and 0.90 (0.87,0.92), respectively. Extensive sensitivity analyses supported the conclusion of no increased mortality in OA. CONCLUSIONS:: In Sweden, RA is associated with about doubled mortality rate, but we found no increased mortality in patients with knee and hip OA. Possible selection of those seeking physician care for knee or hip pain and/or OA management in healthcare are plausible explanations.</p>},
  author       = {Turkiewicz, Aleksandra and Neogi, Tuhina and Björk, Jonas and Peat, George and Englund, Martin},
  issn         = {1044-3983},
  keyword      = {osteoarthritis,Rheumatoid Arthritis,knee and hip arthroplasty},
  language     = {eng},
  month        = {03},
  publisher    = {ARRAY(0xa6934f0)},
  series       = {Epidemiology},
  title        = {All-cause mortality in knee and hip osteoarthritis and rheumatoid arthritis},
  url          = {http://dx.doi.org/10.1097/EDE.0000000000000477},
  year         = {2016},
}