Centers for Disease Control and Prevention, Atlanta, Georgia, and United States Public Health Service, Commissioned Corps, Rockville, Maryland.
University of Pittsburgh, Pittsburgh, Pennsylvania.
Arthritis Care Res (Hoboken). 2019 Jul;71(7):865-874. doi: 10.1002/acr.23725. Epub 2019 Jun 13.
The risk of falls among adults with knee osteoarthritis (OA) has been documented, yet, to our knowledge no studies have examined knee OA and the risk of medically treated injurious falls (overall and by sex), which is an outcome of substantial clinical and public health relevance.
Using data from the Health Aging and Body Composition Knee Osteoarthritis Substudy, a community-based study of white and African American older adults, we tested associations between knee OA status and the risk of injurious falls among 734 participants with a mean ± SD age of 74.7 ± 2.9 years. Knee radiographic OA (ROA) was defined as having a Kellgren-Lawrence grade of ≥2 in at least 1 knee. Knee symptomatic ROA (sROA) was defined as having both ROA and pain symptoms in the same knee. Injurious falls were defined using a validated diagnosis code algorithm from linked Medicare fee-for-service claims. Cox regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs).
The mean ± SD follow-up time was 6.59 ± 3.12 years. Of the 734 participants, 255 (34.7%) had an incident injurious fall over the entire study period. In the multivariate model, compared with those without ROA or pain, individuals with sROA (HR 1.09 [95% CI 0.73-1.65]) did not have a significantly increased risk of injurious falls. Compared with men without ROA or pain, men with sROA (HR 2.57 [95% CI 1.12-5.91]) had a significantly higher risk of injurious falls. No associations were found for women or by injurious fall type.
Knee sROA was independently associated with an increased risk of injurious falls in older men, but not in older women.
已有文献记录了成年人膝骨关节炎（OA）患者的跌倒风险，但据我们所知，尚无研究探讨膝 OA 与经医学治疗的伤害性跌倒（总体及按性别划分）之间的关系，而后者是具有重要临床和公共卫生相关性的结果。
我们利用来自健康老龄化和身体成分膝关节骨关节炎子研究的数据，这是一项针对白人和非裔美国老年人群体的社区基础研究，共纳入了 734 名平均年龄（±标准差）为 74.7±2.9 岁的参与者，检验了膝 OA 状况与伤害性跌倒风险之间的关联。膝关节放射学 OA（ROA）的定义为至少 1 个膝关节的 Kellgren-Lawrence 分级≥2。膝关节有症状性 ROA（sROA）的定义为同一膝关节同时存在 ROA 和疼痛症状。伤害性跌倒通过从医疗保险收费服务索赔中链接的经过验证的诊断代码算法来定义。使用 Cox 回归模型来估计风险比（HR）和 95%置信区间（95%CI）。
平均随访时间（±标准差）为 6.59±3.12 年。在 734 名参与者中，255 人（34.7%）在整个研究期间发生了伤害性跌倒事件。在多变量模型中，与没有 ROA 或疼痛的参与者相比，有 sROA 的个体（HR 1.09[95%CI 0.73-1.65]）伤害性跌倒的风险无显著增加。与没有 ROA 或疼痛的男性相比，有 sROA 的男性（HR 2.57[95%CI 1.12-5.91]）发生伤害性跌倒的风险显著更高。在女性或按伤害性跌倒类型方面均未发现关联。
膝关节 sROA 与老年男性伤害性跌倒风险的增加独立相关，但与老年女性无关。
