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Persons with chronic widespread pain experience excess mortality: longitudinal results from UK Biobank and
Gary J Macfarlane1,2, Maxwell S Barnish1,2, Gareth T Jones1,2
1Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Insights
Individuals with chronic widespread pain (CWP) face significantly higher mortality risks. This increased risk, particularly from cancer and cardiovascular diseases, is linked to lifestyle factors like poor diet and smoking.
Area of Science:
- Epidemiology
- Public Health
- Pain Medicine
Background:
- Chronic widespread pain (CWP) affects millions globally, yet its association with premature mortality remains uncertain.
- Understanding the mortality risk in CWP patients is crucial for public health initiatives and clinical management.
Purpose of the Study:
- To investigate the relationship between chronic widespread pain (CWP) and premature mortality.
- To quantify the excess mortality risk associated with CWP.
- To identify lifestyle factors that may mediate this relationship.
Main Methods:
- Utilized UK Biobank data from over 0.5 million individuals aged 40-69.
- Compared mortality outcomes in participants with CWP versus those without.
- Conducted a meta-analysis with existing studies to determine pooled excess mortality risk.
Main Results:
- CWP was associated with a 2.43-fold increased mortality risk (95% CI 2.17-2.72).
- Excess deaths were observed for cancer, cardiovascular, respiratory, and other disease-related causes.
- Adjustment for physical activity, BMI, diet, and smoking substantially reduced the excess risk.
Conclusions:
- The link between CWP and excess mortality is now clearly established.
- Adverse lifestyle factors appear to explain a significant portion of this excess risk.
- Targeting lifestyle modifications may be key in managing CWP patients and mitigating mortality risk.
Objective:
It is uncertain whether persons with chronic widespread pain (CWP) experience premature mortality. Using the largest study conducted, we determine whether such a relationship exists, estimate its magnitude and establish what factors mediate any relationship.
Methods:
UK Biobank, a cohort study of 0.5 million people aged 40-69 years, recruited throughout Great Britain in 2006-2010. Participants reporting 'pain all over the body' for >3 months were compared with persons without chronic pain. Information on death (with cause) was available until mid-2015. We incorporated these results in a meta-analysis with other published reports to calculate a pooled estimate of excess risk.
Results:
7130 participants reported CWP and they experienced excess mortality (mortality risk ratio 2.43, 95%CI 2.17 to 2.72). Specific causes of death in excess were cancer (1.73adjusted age and sex, 95% CI 1.46 to 2.05), cardiovascular (3.24adjusted age and sex, 95% CI 2.55 to 4.11), respiratory (5.66adjusted age and sex, 95% CI 4.00 to 8.03) and other disease-related causes (4.04adjusted age and sex, 95% CI 3.05 to 5.34). Excess risk was substantially reduced after adjustment for low levels of physical activity, high body mass index, poor quality diet and smoking. In meta-analysis, all studies showed significant excess all-cause (combined estimate 1.59 (95% CI 1.05 to 2.42)), cardiovascular and cancer mortality.
Conclusions:
Evidence is now clear that persons with CWP experience excess mortality. UK Biobank results considerably reduce uncertainty around the magnitude of excess risk and are consistent with the excess being explained by adverse lifestyle factors, which could be targeted in the management of such patients.