Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
Osteoarthritis Cartilage. 2019 Jun;27(6):848-854. doi: 10.1016/j.joca.2019.02.793. Epub 2019 Feb 21.
To estimate cause-specific mortality in osteoarthritis patients compared to the general population.
We identified all residents in southern Sweden aged 45-84 years in 2003. Through the Skåne Healthcare Register (SHR) we identified those diagnosed with osteoarthritis in peripheral joints between 1998 and 2003. We followed all residents from 2004 until relocation outside of the region, death, or end of 2014. We classified the underlying cause of death from death certificates into: cardiovascular and neoplasms, diabetes, infections, dementia, diseases of digestive system, or other causes. For estimation, we used multi-state adjusted Cox proportional hazards models.
We identified 15,901 patients (mean age [SD] 67 years [10], 41% men) with prevalent doctor-diagnosed osteoarthritis in knee, 9347 in hip, 4004 in hand and 5447 in other peripheral joints among 469,177 residents. For most causes of death in osteoarthritis patients, we found no increased mortality, with hazard ratios (HRs) close to 1, similar for men and women. However, for knee and hip osteoarthritis and cardiovascular death, HRs were non proportional and increased to 1.19 (95%CI 1.10, 1.28) and 1.13 (1.03, 1.24) during 9-11 years of follow-up, mostly due to excess mortality from chronic ischemic heart diseases and heart failure.
The risk of cardiovascular excess deaths increases with duration of knee and hip osteoarthritis. The major contributors are chronic ischemic heart diseases and heart failure. Our results call for improved implementation of osteoarthritis treatment guidelines, with major focus on interventions to address mobility limitations and maintaining or increase physical activity level.
评估与普通人群相比，骨关节炎患者的特定病因死亡率。
我们确定了 2003 年瑞典南部所有 45-84 岁的居民。通过斯科讷医疗登记处（SHR），我们确定了 1998 年至 2003 年期间在周围关节处被诊断患有骨关节炎的患者。我们从 2004 年开始对所有居民进行随访，直到他们搬迁到该地区之外、死亡或 2014 年底。我们根据死亡证明将死亡的根本原因分为：心血管疾病和肿瘤、糖尿病、感染、痴呆、消化系统疾病或其他原因。为了进行评估，我们使用了多状态调整的 Cox 比例风险模型。
我们在 469177 名居民中确定了 15901 名患有膝关节、9347 名髋关节、4004 名手部和 5447 名其他外周关节的现患医生诊断为骨关节炎的患者（平均年龄[标准差]67 岁[10]，41%为男性）。对于大多数骨关节炎患者的死因，我们发现死亡率没有增加，风险比（HR）接近 1，男性和女性相似。然而，对于膝关节和髋关节骨关节炎以及心血管疾病死亡，HR 不成比例，在 9-11 年的随访期间增加到 1.19（95%CI 1.10，1.28）和 1.13（1.03，1.24），主要是由于慢性缺血性心脏病和心力衰竭导致的过度死亡。
膝关节和髋关节骨关节炎的持续时间越长，心血管疾病死亡的风险就越高。主要原因是慢性缺血性心脏病和心力衰竭。我们的结果呼吁加强实施骨关节炎治疗指南，主要重点是采取干预措施来解决活动能力受限和保持或增加身体活动水平的问题。
