Knee Symptomatic Osteoarthritis, Walking Disability, NSAIDs Use and All-cause Mortality: Population-based Wuchuan Osteoarthritis Study

Qiang Liu, Jingbo Niu, Hu Li, Yan Ke, Rujun Li, Yuqing Zhang, Jianhao Lin, Qiang Liu, Jingbo Niu, Hu Li, Yan Ke, Rujun Li, Yuqing Zhang, Jianhao Lin

Abstract

Knee symptomatic osteoarthritis (SxOA) was associated with all-cause mortality. Walking disability and NSAIDs use have been postulated as potential mechanisms linking knee SxOA to all-cause mortality. Data were collected on ability of walking for 1 kilometer and use of NSAIDs at baseline and death information at follow-up. Subjects with knee SxOA were identified if at least one knee had both radiographic OA and pain. We first fitted a Cox proportional hazards model to examine the relation of knee SxOA to the risk of all-cause mortality. We then used marginal structural models to decompose total effect of knee SxOA on all-cause mortality into indirect and direct effects via walking disability and use of NSAIDs, respectively. Among 1025 subjects, 99 died over 8 years of follow-up. A multivariable adjusted hazard ratio of mortality for SxOA was 1.98 (95% CI: 1.09-3.62). The indirect effect of knee SxOA on all-cause mortality through either a walking disability or NSAIDs use was 1.92 (95% CI: 0.86-4.26) and 1.45 (95% CI: 0.72-2.92), respectively. The corresponding direct effect was 1.08 (95% CI: 0.55-1.12) and 1.35 (95% CI: 0.75-2.44). In this population-based cohort study, high all-cause mortality from knee SxOA was mediated mainly through a walking disability.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
A directed acyclic graph to describe the hypotheses: we decomposed the total effect of knee symptomatic osteoarthritis (SxOA) on all-cause mortality into two components: 1) the indirect effect (or mediated effect), i.e., the effect of knee SxOA on all-cause mortality mediated through either a walking disability (knee SxOA → walking disability → death) or Nonsteroidal antiinflammatory drugs (NSAIDs) use (knee SxOA → NSAIDs → death), and 2) the direct effect, i.e., the effect of knee SxOA on all-cause mortality (knee SxOA → death) that was not through either a walking disability or use of NSAIDS. The dotted line between walking disability and NSAIDs indicated that the time sequence was uncertain. CF: confounders.

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Source: PubMed

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