Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen, Aberdeen, UK.
Ann Rheum Dis. 2017 Nov;76(11):1815-1822. doi: 10.1136/annrheumdis-2017-211476. Epub 2017 Jul 21.
It is uncertain whether persons with chronic widespread pain (CWP) experience premature mortality. Using the largest study conducted, we determine whether such a relationship exists, estimate its magnitude and establish what factors mediate any relationship.
UK Biobank, a cohort study of 0.5 million people aged 40-69 years, recruited throughout Great Britain in 2006-2010. Participants reporting 'pain all over the body' for >3 months were compared with persons without chronic pain. Information on death (with cause) was available until mid-2015. We incorporated these results in a meta-analysis with other published reports to calculate a pooled estimate of excess risk.
7130 participants reported CWP and they experienced excess mortality (mortality risk ratio 2.43, 95%CI 2.17 to 2.72). Specific causes of death in excess were cancer (1.73, 95% CI 1.46 to 2.05), cardiovascular (3.24, 95% CI 2.55 to 4.11), respiratory (5.66, 95% CI 4.00 to 8.03) and other disease-related causes (4.04, 95% CI 3.05 to 5.34). Excess risk was substantially reduced after adjustment for low levels of physical activity, high body mass index, poor quality diet and smoking. In meta-analysis, all studies showed significant excess all-cause (combined estimate 1.59 (95% CI 1.05 to 2.42)), cardiovascular and cancer mortality.
Evidence is now clear that persons with CWP experience excess mortality. UK Biobank results considerably reduce uncertainty around the magnitude of excess risk and are consistent with the excess being explained by adverse lifestyle factors, which could be targeted in the management of such patients.
患有慢性广泛性疼痛（CWP）的人是否会过早死亡尚不确定。我们使用进行的最大规模的研究来确定是否存在这种关系，估计其程度，并确定哪些因素可以调解这种关系。
英国生物库是一项针对 050 万名年龄在 40-69 岁之间的人群的队列研究，于 2006-2010 年在英国各地招募。报告“全身疼痛”超过 3 个月的参与者与没有慢性疼痛的人进行了比较。截至 2015 年年中，可获得有关死亡（包括死因）的信息。我们将这些结果纳入荟萃分析，并与其他已发表的报告相结合，以计算出超额风险的汇总估计值。
7130 名参与者报告患有 CWP，他们经历了超额死亡（死亡率风险比为 2.43，95%CI 2.17 至 2.72）。超额死亡的具体原因包括癌症（1.73，95%CI 1.46 至 2.05）、心血管疾病（3.24，95%CI 2.55 至 4.11）、呼吸系统疾病（5.66，95%CI 4.00 至 8.03）和其他与疾病相关的原因（4.04，95%CI 3.05 至 5.34）。在调整了低水平的身体活动、高身体质量指数、不良饮食和吸烟等因素后，超额风险大大降低。荟萃分析中，所有研究均显示出全因死亡率（综合估计值为 1.59（95%CI 1.05 至 2.42））、心血管疾病和癌症死亡率显著增加。
现在有明确的证据表明，患有 CWP 的人会过早死亡。英国生物库的结果大大降低了超额风险程度的不确定性，并且与因不良生活方式因素导致的超额风险相一致，这些因素可以作为此类患者管理的目标。
