Knee osteoarthritis and time-to all-cause mortality in six community-based cohorts: an international meta-analysis of individual participant-level data

• Published in: Aging clinical and experimental research Vol. 33; no. 3; pp. 529 - 545
• Main Authors: Leyland, Kirsten M., Gates, Lucy S., Sanchez-Santos, Maria T., Nevitt, Michael C., Felson, David, Jones, Graeme, Jordan, Joanne M., Judge, Andrew, Prieto-Alhambra, Dani, Yoshimura, Noriko, Newton, Julia L., Callahan, Leigh F., Cooper, Cyrus, Batt, Mark E., Lin, Jianhao, Liu, Qiang, Cleveland, Rebecca J., Collins, Gary S., Arden, Nigel K.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2021; Springer Nature B.V
• Subjects: Age; Arthritis; Cardiovascular Diseases; Geriatrics/Gerontology; Humans; Knee; Knee Joint; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Original; Original Article; Osteoarthritis; Osteoarthritis, Knee - diagnostic imaging; Pain; Population; Radiography; Knee; Osteoarthritis; Mortality; Meta-analysis
• ISSN: 1720-8319; 1594-0667; 1720-8319
• DOI: 10.1007/s40520-020-01762-2

Background Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population. Methods Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung–Knapp modification for random-effects meta-analysis. Findings 10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA. Discussion Participants with POA or PROA had a 35–37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality. Funding Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.