All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study.
All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study.
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DOI：
10.1136/bmj.d1165
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发表时间：
2011-03-08
期刊：
影响因子：
--
通讯作者：
Jüni P
中科院分区：
文献类型：
--
作者：
Nüesch E;Dieppe P;Reichenbach S;Williams S;Iff S;Jüni P
目的 检查膝关节或髋关节骨关节炎患者的所有原因和疾病特异性死亡率。设计基于人群的队列研究。在英格兰西南部制定一般惯例。参与者 1163 名年龄在 35 岁或以上、有膝关节或髋关节骨关节炎症状并经放射学证实的患者。主要结果衡量中位 14 年随访后的年龄和性别标准化死亡率以及死亡的多变量风险比。结果 与普通人群相比，骨关节炎患者的全因死亡率过高（标准化死亡率为 1.55，95% 置信区间为 1.41 至 1.70）。所有疾病特定死因均观察到超额死亡率，但心血管疾病（标准化死亡率 1.71、1.49 至 1.98）和痴呆相关死亡率（1.99、1.22 至 3.25）尤其明显。死亡率随着年龄（趋势P<0.001）、男性（调整后风险比1.59、1.30至1.96）、自我报告的糖尿病史（1.95、1.31至2.90）、癌症（2.28、1.50至3.47）、心血管疾病（1.38、1.12至1.71）和步行障碍的增加而增加（1.48、1.17 至 1.86）。然而，几乎没有证据表明死亡率增加与既往关节置换、肥胖、抑郁、慢性炎症性疾病、眼病或基线疼痛有关。步行障碍越严重，死亡风险越高（趋势 P <0.001）。结论 与普通人群相比，骨关节炎患者的死亡风险更高。糖尿病、癌症或心血管疾病史以及行走障碍是主要的危险因素。骨关节炎和行走障碍患者的治疗应侧重于有效治疗心血管危险因素和合并症，以及增加体力活动。
Objective To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip. Design Population based cohort study. Setting General practices in the southwest of England. Participants 1163 patients aged 35 years or over with symptoms and radiological confirmation of osteoarthritis of the knee or hip. Main outcome measures Age and sex standardised mortality ratios and multivariable hazard ratios of death after a median of 14 years’ follow-up. Results Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70). Excess mortality was observed for all disease specific causes of death but was particularly pronounced for cardiovascular (standardised mortality ratio 1.71, 1.49 to 1.98) and dementia associated mortality (1.99, 1.22 to 3.25). Mortality increased with increasing age (P for trend <0.001), male sex (adjusted hazard ratio 1.59, 1.30 to 1.96), self reported history of diabetes (1.95, 1.31 to 2.90), cancer (2.28, 1.50 to 3.47), cardiovascular disease (1.38, 1.12 to 1.71), and walking disability (1.48, 1.17 to 1.86). However, little evidence existed for increased mortality associated with previous joint replacement, obesity, depression, chronic inflammatory disease, eye disease, or presence of pain at baseline. The more severe the walking disability, the higher was the risk of death (P for trend <0.001). Conclusion Patients with osteoarthritis are at higher risk of death compared with the general population. History of diabetes, cancer, or cardiovascular disease and the presence of walking disability are major risk factors. Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.
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DOI：
10.2106/00004623-200407000-00013
发表时间：
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影响因子：
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