TY - JOUR
T1 - Knee Osteoarthritis, Potential Mediators, and Risk of All-Cause Mortality
T2 - Data From the Osteoarthritis Initiative
AU - Wang, Yilun
AU - Nguyen, Uyen Sa D.T.
AU - Lane, Nancy E.
AU - Lu, Na
AU - Wei, Jie
AU - Lei, Guanghua
AU - Zeng, Chao
AU - Zhang, Yuqing
N1 - Publisher Copyright:
© 2020, American College of Rheumatology
PY - 2021/4
Y1 - 2021/4
N2 - Objective: To assess the relation of symptomatic knee osteoarthritis (OA), knee pain, and radiographic knee OA to All-cause mortality and to identify mediators in the causal pathway. Methods: Participants from the Osteoarthritis Initiative were divided into 4 groups: 1) symptomatic knee OA (i.e., both radiographic knee OA [Kellgren/Lawrence grade ≥2] and knee pain); 2) knee pain only; 3) radiographic knee OA only; and 4) neither radiographic knee OA nor knee pain. We examined the relation of knee OA status to All-cause mortality using a multivariable Cox proportional hazards model and assessed the extent to which the association was mediated by disability, physical component summary (PCS) and mental component summary (MCS) scores for quality of life (QoL), and use of oral pain-relief medications (i.e., nonsteroidal antiinflammatory drugs and opioids). Results: Among 4,796 participants, 282 died over the 96-month follow-up period. Compared with those with neither radiographic knee OA nor knee pain, multivariable-adjusted hazard ratios (HRs) of mortality were 2.2 (95% confidence interval [95% CI] 1.6–3.1) for symptomatic knee OA, 0.9 (95% CI 0.6–1.4) for knee pain only, and 2.0 (95% CI 1.4–2.9) for radiographic knee OA only, respectively. Indirect effects (HRs) of symptomatic knee OA on mortality via disability and PCS of QoL were 1.1 (95% CI 1.0–1.4) and 1.2 (95% CI 1.0–1.4), respectively. No apparent mediation effect was observed through either MCS of QoL or oral pain-relief medications use. Conclusion: Participants with either symptomatic or radiographic knee OA were at an increased risk of All-cause mortality. Increased risk of mortality from symptomatic knee OA was partially mediated through its effect on disability and PCS of QoL.
AB - Objective: To assess the relation of symptomatic knee osteoarthritis (OA), knee pain, and radiographic knee OA to All-cause mortality and to identify mediators in the causal pathway. Methods: Participants from the Osteoarthritis Initiative were divided into 4 groups: 1) symptomatic knee OA (i.e., both radiographic knee OA [Kellgren/Lawrence grade ≥2] and knee pain); 2) knee pain only; 3) radiographic knee OA only; and 4) neither radiographic knee OA nor knee pain. We examined the relation of knee OA status to All-cause mortality using a multivariable Cox proportional hazards model and assessed the extent to which the association was mediated by disability, physical component summary (PCS) and mental component summary (MCS) scores for quality of life (QoL), and use of oral pain-relief medications (i.e., nonsteroidal antiinflammatory drugs and opioids). Results: Among 4,796 participants, 282 died over the 96-month follow-up period. Compared with those with neither radiographic knee OA nor knee pain, multivariable-adjusted hazard ratios (HRs) of mortality were 2.2 (95% confidence interval [95% CI] 1.6–3.1) for symptomatic knee OA, 0.9 (95% CI 0.6–1.4) for knee pain only, and 2.0 (95% CI 1.4–2.9) for radiographic knee OA only, respectively. Indirect effects (HRs) of symptomatic knee OA on mortality via disability and PCS of QoL were 1.1 (95% CI 1.0–1.4) and 1.2 (95% CI 1.0–1.4), respectively. No apparent mediation effect was observed through either MCS of QoL or oral pain-relief medications use. Conclusion: Participants with either symptomatic or radiographic knee OA were at an increased risk of All-cause mortality. Increased risk of mortality from symptomatic knee OA was partially mediated through its effect on disability and PCS of QoL.
UR - http://www.scopus.com/inward/record.url?scp=85078764728&partnerID=8YFLogxK
U2 - 10.1002/acr.24151
DO - 10.1002/acr.24151
M3 - Article
C2 - 31961495
AN - SCOPUS:85078764728
SN - 2151-464X
VL - 73
SP - 566
EP - 573
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 4
ER -