Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model
Objectives To identify potentially modifiable factors that mediate the association between symptomatic osteoarthritis (OA) and premature mortality.Methods A population-based prospective cohort study; primary care medical record data were linked to self-report information collected by questionnaire i...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-11-01
|
| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/5/2/e001048.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1825201880636063744 |
|---|---|
| author | George Peat Martin J Thomas Milica Blagojevic-Bucknall Ross Wilkie Simran Singh Parmar Diane Smith Bethany Jane Seale Gemma Mansell |
| author_facet | George Peat Martin J Thomas Milica Blagojevic-Bucknall Ross Wilkie Simran Singh Parmar Diane Smith Bethany Jane Seale Gemma Mansell |
| author_sort | George Peat |
| collection | DOAJ |
| description | Objectives To identify potentially modifiable factors that mediate the association between symptomatic osteoarthritis (OA) and premature mortality.Methods A population-based prospective cohort study; primary care medical record data were linked to self-report information collected by questionnaire in adults aged 50 years and over (n=10 415). OA was defined by primary care consultation and moderate-to-severe pain interference in daily life. A Cox proportional hazards analysis determined the total effect (TE) of OA on mortality after adjustment for potential confounders. Within the Cox model, path analysis was used to decompose the TE to assess the indirect and direct effects for selected potential mediators (anxiety, depression, unrefreshed sleep and walking frequency). Results are expressed as HRs with 95% CIs derived from bootstrap resampling.Results OA was significantly associated with mortality (TE-adjusted HR 1.14; 95% CI 1.00 to 1.29). The indirect effects for walking frequency were 1.05 (95% CI 1.04 to 1.06), depression 1.02 (95% CI 1.02 to 1.03), anxiety 1.01 (95% CI 1.00 to 1.02) and unrefreshed sleep 1.01 (95% CI 1.00 to 1.01).Conclusions The analysis indicates that encouraging people to walk and ‘get out and about’ in addition to targeting OA could be protective against excessive mortality. The findings also suggest that depression, anxiety and unrefreshed sleep have a role in premature mortality for people with OA; however, this has low clinical significance. |
| format | Article |
| id | doaj-art-0e87bd4f9a7948feaad5a4c1661fa32b |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | RMD Open |
| spelling | doaj-art-0e87bd4f9a7948feaad5a4c1661fa32b2025-02-07T18:30:09ZengBMJ Publishing GroupRMD Open2056-59332019-11-015210.1136/rmdopen-2019-001048Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards modelGeorge Peat0Martin J Thomas1Milica Blagojevic-Bucknall2Ross Wilkie3Simran Singh Parmar4Diane Smith5Bethany Jane Seale6Gemma Mansell7Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UKPrimary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UKPrimary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UKSchool of Medicine, Keele University, Newcastle-under-Lyme, UKKeele Medical School, Keele University, Keele, UKManchester Metropolitan University, Manchester, UKKeele Medical School, Keele University, Keele, UKSchool of Life and Health Sciences, Aston University, Birmingham, UKObjectives To identify potentially modifiable factors that mediate the association between symptomatic osteoarthritis (OA) and premature mortality.Methods A population-based prospective cohort study; primary care medical record data were linked to self-report information collected by questionnaire in adults aged 50 years and over (n=10 415). OA was defined by primary care consultation and moderate-to-severe pain interference in daily life. A Cox proportional hazards analysis determined the total effect (TE) of OA on mortality after adjustment for potential confounders. Within the Cox model, path analysis was used to decompose the TE to assess the indirect and direct effects for selected potential mediators (anxiety, depression, unrefreshed sleep and walking frequency). Results are expressed as HRs with 95% CIs derived from bootstrap resampling.Results OA was significantly associated with mortality (TE-adjusted HR 1.14; 95% CI 1.00 to 1.29). The indirect effects for walking frequency were 1.05 (95% CI 1.04 to 1.06), depression 1.02 (95% CI 1.02 to 1.03), anxiety 1.01 (95% CI 1.00 to 1.02) and unrefreshed sleep 1.01 (95% CI 1.00 to 1.01).Conclusions The analysis indicates that encouraging people to walk and ‘get out and about’ in addition to targeting OA could be protective against excessive mortality. The findings also suggest that depression, anxiety and unrefreshed sleep have a role in premature mortality for people with OA; however, this has low clinical significance.https://rmdopen.bmj.com/content/5/2/e001048.full |
| spellingShingle | George Peat Martin J Thomas Milica Blagojevic-Bucknall Ross Wilkie Simran Singh Parmar Diane Smith Bethany Jane Seale Gemma Mansell Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model RMD Open |
| title | Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model |
| title_full | Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model |
| title_fullStr | Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model |
| title_full_unstemmed | Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model |
| title_short | Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model |
| title_sort | reasons why osteoarthritis predicts mortality path analysis within a cox proportional hazards model |
| url | https://rmdopen.bmj.com/content/5/2/e001048.full |
| work_keys_str_mv | AT georgepeat reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel AT martinjthomas reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel AT milicablagojevicbucknall reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel AT rosswilkie reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel AT simransinghparmar reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel AT dianesmith reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel AT bethanyjaneseale reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel AT gemmamansell reasonswhyosteoarthritispredictsmortalitypathanalysiswithinacoxproportionalhazardsmodel |