Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis

Abstract

Objectives: Osteoarthritis (OA) is a leading cause of disability, but the relationship with premature mortality remains uncertain. We aimed to investigate the relationship between OA and mortality from any cause and from cardiovascular disease (CVD).Methods: Electronic literature databases searches were conducted to identify prospective studies comparing mortality in a sample of people with and without OA.Risk of call-cause and CVD-mortality were summarized using adjusted hazard ratios (HRs) for joint-specific (hand, hip and knee) and joint non-specific OA. New data from the Progetto Veneto Anziani (PRO.V.A.) study were also included.Results: From the PRO.V.A. study (N=2,927), there was no significant increase in CVD mortality risk for participants with any-joint OA (N=1,858) compared to non-OA (all-cause, HR=0.95; 95% CI: 0.77-1.15; CVD, HR=1.12; 95% CI: 0.82-1.54).On meta-analysis, seven studies (OA: 10,018/non-OA: 18,541), with a median 12-year follow-up, reported no increased risk of any-cause mortality in those with OA (HR=1.10; 95% CI: 0.97-1.25). After removing data on hand OA, a significant association between OA and mortality was observed (HR=1.18; 95% CI: 1.08-1.28).There was a significant higher risk of overall mortality for (1) studies conducted in Europe, (2) patients with multi-joint OA; and (3) a radiological diagnosis of OA. OA was associated with significantly higher CVD mortality (HR=1.21; 95% CI: 1.10-1.34). CVD is potentially preventable through appropriate timely pharmacological and non-pharmacological interventions 10 Therefore, to identify people at higher risk of CVD mortality could be of considerable public health importance.Within the past decade, a number of observational studies have reported that people with OA are at increased risk of premature mortality compared to the general population. [11][12][13] However, this evidence is heterogeneous and limited by the lack of adjustment for appropriate confounders.Given this, the purpose of this study was to: i) analyze data from a prospective cohort study on the risk of CVD mortality in OA compared to a non-osteoarthritis cohort, adjusting for important medical morbidities and other confounders; ii) to systematically review the available literature and perform a meta-analysis to 7 determine whether people with OA present a differential risk of overall and CVD mortality than those without OA. We hypothesized that people with OA had a significant higher risk of overall and CVD death compared to those without OA. 8 MATERIALS AND METHODS Prospective cohort study Overall cohortPreviously unpublished data from the Progetto Veneto Anziani (PRO.V.A. study)were used to investigate the risk of overall and CVD mortality in people with OA over a mean follow-up of 4.4 years. The Pro.V.A. study is an observational cohort study on the Italian population aged over 65 years. The study population initially included 3,099 older Caucasian adults (1,245 men/1,854 women), who were randomly selected between 1995 and 1997 using a multistage stratified met...

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“…Veronese et al [8][9][10] performed a meta-analysis of the literature and found that hip or knee OA was associated with increased mortality (HR 1.18[95% CI 1.08-1.28]). 8 This study also found that hip or knee OA was associated with a 21% increase in cardiovascular mortality.…”

“…Veronese et al [8][9][10] performed a meta-analysis of the literature and found that hip or knee OA was associated with increased mortality (HR 1.18[95% CI 1.08-1.28]). 8 This study also found that hip or knee OA was associated with a 21% increase in cardiovascular mortality. Leyland et al has presented data utilizing an individualized patient-level meta-analysis of 9889 persons from six population based cohort studies, as well as a similar review of 36,884 persons from nine cohorts 9,10 The latter study was presented in the Osteoarthritis Research Society International's white paper to the US Food and Drug Administration in 2016.…”