All-cause Mortality in Knee and Hip Osteoarthritis and Rheumatoid Arthritis
All-cause Mortality in Knee and Hip Osteoarthritis and Rheumatoid Arthritis
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DOI：
10.1097/ede.0000000000000477
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发表时间：
2016-07-01
期刊：
影响因子：
5.4
通讯作者：
Englund, Martin
中科院分区：
文献类型：
--
作者：
Turkiewicz, Aleksandra;Neogi, Tuhina;Englund, Martin
背景：虽然类风湿关节炎（RA）的死亡率增加是众所周知的，但骨关节炎（OA）与死亡率之间的关系存在相互矛盾的证据。我们的目的是估计瑞典RA和OA患者与普通人群相比的全因死亡率。方法：对瑞典Skane地区（130万）人口进行队列研究，基于覆盖所有医疗保健机构的强制性登记册中的医生诊断代码。我们纳入了所有在1998年至2012年间至少咨询过一次医生的年龄在bb0 = 45岁的受试者。我们确定了那些被诊断为RA、膝关节OA或髋关节OA的患者。我们对所有受试者进行随访，直到死亡、搬迁到Skane地区以外或2013年底，并以达到的年龄为时间尺度，使用Cox比例风险回归分析数据。结果：我们在524,136例年龄为bb0 = 45岁的人群中确定了8,067例RA患者，51,939例膝关节OA患者和29,442例髋关节OA患者。经性别、社会经济地位和合并症调整后的RA死亡率升高，风险比为1.86(95%可信区间= 1.78,1.94)，但与寻求医疗保健的普通人群相比，膝关节或髋关节OA的死亡率没有升高，风险比分别为0.87（0.85,0.89）和0.90（0.87,0.92）。广泛的敏感性分析支持OA患者死亡率没有增加的结论。结论：在瑞典，RA与大约两倍的死亡率相关，但我们发现膝关节和髋关节OA患者的死亡率没有增加。可能选择那些在医疗保健中因膝关节或髋关节疼痛和/或OA管理而寻求医生护理的人是合理的解释。
Background: While increased mortality in rheumatoid arthritis (RA) is well established, there is conflicting evidence on the association between osteoarthritis (OA) and mortality. Our aim was to estimate all-cause mortality in Swedish patients with RA and OA compared with the general population.Methods: Cohort study of the population of Skane region, Sweden (1.3 million), based on physicians' diagnostic codes in a mandatory register covering all health care. We included all subjects aged >= 45 years who between 1998 and 2012 consulted any physician at least once. We identified those who received a diagnosis of RA, knee OA, or hip OA. We followed all subjects until death, relocation outside Skane region, or end of 2013, and analyzed data using Cox proportional hazard regression with attained age as time scale.Results: We identified 8,067 patients with RA, 51,939 with knee OA and 29,442 with hip OA among 524,136 in the population aged >= 45 years. The mortality rates adjusted for sex, socioeconomic status, and comorbidities were elevated for RA, hazard ratio 1.86 (95% confidence interval = 1.78, 1.94) but not in knee or hip OA compared with the general population seeking health care, hazard ratio 0.87 (0.85, 0.89) and 0.90 (0.87, 0.92), respectively. Extensive sensitivity analyses supported the conclusion of no increased mortality in OA.Conclusions: In Sweden, RA is associated with about doubled mortality rate, but we found no increased mortality in patients with knee and hip OA. Possible selection of those seeking physician care for knee or hip pain and/or OA management in health care are plausible explanations.