文化程度较低是否会增加骨关节炎手术的风险？一项瑞典双胞胎研究。

Does lower educational attainment increase the risk of osteoarthritis surgery? a Swedish twin study.

机构信息

Faculty of Medicine, Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, OrthopaedicsLund, Sweden.

Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway.

出版信息

BMC Musculoskelet Disord. 2023 Jan 28;24(1):72. doi: 10.1186/s12891-023-06163-w.

DOI:10.1186/s12891-023-06163-w

PMID:36707830

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9883874/

Abstract

BACKGROUND

Previous studies have reported an inverse association between educational attainment and different osteoarthritis (OA) outcomes. However, none of the previous studies have accounted for potential confounding by early-life environment and genetics. Thus, we aimed to examine the association between educational attainment and knee and hip OA surgery using twin data.

METHODS

From the Swedish Twin Registry (STR), we identified dizygotic (DZ) and monozygotic (MZ) twins. All twins in the STR aged 35 to 64 years were followed from January the 1 1987 or the date they turned 35 years until OA surgery, relocation outside Sweden, death or the end of 2016 (18,784 DZ and 8,657 MZ complete twin pairs). Associations between educational attainment and knee and hip OA surgery were estimated in models matched on twin pairs, using Weibull within-between (WB) shared frailty model.

RESULTS

For knee OA surgery, the analysis matched on MZ twins yielded a within-estimate hazard ratio (HR) per 3 years of education, of 1.06 (95% CI: 0.81, 1.32), suggesting no association between the outcome and the individual´s education. Rather, there seemed to be a so called familial effect of education, with a between-pair estimate of HR = 0.71 (95% CI: 0.41, 1.01). For hip OA surgery, the within- and between-pair estimates for MZ twins were 0.92 (95% CI: 0.69, 1.14) and 1.15 (95% CI: 0.87, 1.42), respectively.

CONCLUSIONS

Our results suggest that the inverse associations between education and knee/hip OA surgery observed in cohort studies are potentially confounded by unobserved familial factors like genetics and/or early life exposures.

摘要

背景

先前的研究报告称，教育程度与不同的骨关节炎（OA）结局呈负相关。然而，以前的研究都没有考虑到早期生活环境和遗传因素的潜在混杂作用。因此，我们旨在使用双胞胎数据研究教育程度与膝关节和髋关节 OA 手术之间的关系。

方法

我们从瑞典双胞胎登记处（STR）中确定了异卵（DZ）和同卵（MZ）双胞胎。STR 中所有年龄在 35 至 64 岁之间的双胞胎从 1987 年 1 月 1 日或他们年满 35 岁之日开始随访，直至 OA 手术、搬离瑞典、死亡或 2016 年底（18,784 对 DZ 和 8,657 对 MZ 完整双胞胎对）。我们在基于双胞胎匹配的模型中，使用 Weibull 内-间（WB）共享脆弱性模型，估计了教育程度与膝关节和髋关节 OA 手术之间的关系。

结果

对于膝关节 OA 手术，基于 MZ 双胞胎的分析得出的每 3 年教育程度的危险比（HR）的内部估计值为 1.06（95%CI：0.81，1.32），表明该结果与个体的教育程度之间没有关联。相反，似乎存在教育程度的所谓家族效应，配对间估计的 HR 为 0.71（95%CI：0.41，1.01）。对于髋关节 OA 手术，MZ 双胞胎的内部和配对间估计值分别为 0.92（95%CI：0.69，1.14）和 1.15（95%CI：0.87，1.42）。