Hip Osteoarthritis and Risk Of All Cause and Disease-Specific Mortality Among Older Women: A Population-Based Cohort Study

Kamil E. Barbour¹, Li-Yung Lui², Charles G. Helmick³, Kristina A. Theis⁴, Michael C. Nevitt⁵, Nancy E. Lane⁶, Louise Murphy¹, Jennifer M. Hootman⁷, Marc C. Hochberg⁸ and Jane A. Cauley⁹, ¹Centers for Disease Control and Prevention, Atlanta, GA, ²California Pacific Medical Center, San Francisco, CA, San Francisco, CA, ³National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, ⁴Athritis Program, Centers for Disease Control and Prevention, Atlanta, GA, ⁵Epidemiology & Biostatistics, UCSF (University of California, San Francisco), San Francisco, CA, ⁶Internal Medicine, Center for Musculoskeletal Health, UC Davis School of Medicine, Sacramento, CA, ⁷Division of Population Health, Centers for Disease Control and Prevention, Kennesaw, GA, ⁸Medicine, University of Maryland School of Medicine, Baltimore, MD, ⁹Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Hip, morbidity and mortality and osteoarthritis

Session Information

Title: Epidemiology and Health Services I

Session Type: Abstract Submissions (ACR)

Background/Purpose: The morbidity of osteoarthritis (OA) is well documented; however few comprehensive studies have examined the effect of OA on mortality.

Methods: We used data from the Study of Osteoporotic Fractures, a US population-based cohort study of 9704 white women, ages 65 years or older. Hip radiographs were obtained at baseline (1986-1988) and visit 5 (1995-1996). A summary Croft grade of 0–4 for each hip was based on 5 individual radiographic features: joint space narrowing (JSN), osteophytes, subchondral sclerosis, cysts formation, and deformity of the femoral head. Radiographic hip OA (RHOA) was defined as having Croft grade of ≥2 in at least one hip (definite JSN or osteophytes plus one other radiographic feature). Clinical hip OA (CHOA) was defined as having both RHOA and self-report of hip pain “on most days for at least one month in the year” in the same hip. Mortality was confirmed through July, 2012 by death certificates and hospital discharge summaries, if available. All-cause mortality (cumulative incidence=64%) was analyzed along with three disease-specific causes of death (ICD-9-CM, cumulative incidence): cardiovascular disease (CVD) (390-459.9, 24.8%), total cancer (140-239.9, 11.5%), gastrointestinal disease (520-579.9, 1.8%), and all other causes (25.9%). Cox proportional hazards regression with time-dependent covariates (at baseline and visit 5) were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). All disease-specific mortality models accounted for competing risks of mortality.

Results: Mean follow-up time was 16.0 ± 6.1 years. The baseline prevalence of RHOA and CHOA was 7.4% and 3.2%, respectively, whereas the visit 5 prevalence was higher (9.7% and 3.9%, respectively). Having RHOA was associated with increased risk of all-cause [HR: 1.20; 95% CI: (1.10, 1.31)] and CVD [HR: 1.29; 95% CI: (1.13, 1.48)] mortality after adjusting for age, body mass index, health status, walking for exercise, diabetes, and stroke. Adjusting for potential mediating factors (i.e., physical function, falls, and disability) did not markedly attenuate these associations. CHOA was not associated with all-cause or any disease-specific mortality outcomes.

Conclusion: RHOA was associated with an increased risk of all-cause and CVD mortality in a cohort of older white women followed for a mean of 16 years.

Disclosure:

K. E. Barbour,
None;

L. Y. Lui,
None;

C. G. Helmick,
None;

K. A. Theis,
None;

M. C. Nevitt,
None;

N. E. Lane,
None;

L. Murphy,
None;

J. M. Hootman,
None;

M. C. Hochberg,
None;

J. A. Cauley,
None.

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