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Hip symptoms are associated with premature mortality: the Johnston County Osteoarthritis Project
R J Cleveland1, C Alvarez2, A E Nelson1
1Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Insights
Hip pain alone, without radiographic osteoarthritis, increases mortality risk, especially in younger Caucasians. Addressing hip symptoms may reduce premature deaths.
Area of Science:
- Orthopedics
- Epidemiology
- Gerontology
Background:
- Hip osteoarthritis (OA) is a common degenerative joint disease.
- Excess mortality associated with hip OA and symptoms requires further investigation.
Purpose of the Study:
- To examine the impact of hip osteoarthritis (OA) and/or hip symptoms on all-cause mortality.
- To identify specific demographic groups at higher risk.
Main Methods:
- Analysis of a community-based prospective cohort of 3,919 African Americans and Caucasians (age ≥45).
- Hip radiographic OA (rOA) defined by Kellgren-Lawrence grade ≥2.
- Cox proportional hazards regression used to assess mortality risk.
- Stratified analyses by sex, race, age, and obesity.
Main Results:
- Hip symptoms alone, without radiographic OA, were associated with a 28% increased risk of all-cause mortality (HR=1.28, 95% CI=1.13-1.46).
- No significant mortality association was found for radiographic OA with or without symptoms.
- Increased mortality risk for hip symptoms alone and symptomatic hip rOA was observed in individuals <65 years and in Caucasians.
Conclusions:
- Hip symptoms, even without radiographic evidence of OA, are linked to increased mortality.
- This association is particularly pronounced in younger (<65 years) and Caucasian populations.
- Interventions targeting hip pain could potentially reduce premature mortality.
Objective:
To investigate the impact of hip osteoarthritis (OA) and/or hip symptoms on excess mortality.
Design:
We analyzed data from 3,919 individuals in a community-based prospective cohort of African Americans and Caucasians age ≥45 years. Women ≥50 years of age and all men underwent supine anteroposterior pelvic radiography at baseline, with the participant's feet in 15 degrees of internal rotation. Hip radiographic (rOA) was defined as a Kellgren-Lawrence grade of ≥2 in at least one hip. Participants completed questionnaires at baseline to determine presence of hip symptoms and covariate status. Participants with symptomatic hip rOA (SxOA) are a subset of individuals with hip rOA and symptoms in the same hip. Multiple imputation was used to impute missing values of covariates. Mortality was determined through 2015 and follow-up time was calculated from baseline assessment until death or censoring which took place when a participant was lost to follow-up or reached the end of study period. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). We carried out additional analyses stratified by sex, race, age and obesity.
Results:
Mean follow-up time was 14.2 years during which 1762 deaths occurred. There were 29.9% participants in our population with hip rOA at baseline. Compared to those with neither hip rOA nor hip symptoms, we observed an increased risk of all-cause mortality in participants with hip symptoms alone (HR = 1.28, 95% CI = 1.13-1.46), but no association for hip rOA either with or without symptoms. In stratified analyses we observed increased associations for hip symptoms alone and hip sxOA in those <65 years (43% and 39% increase, respectively) and in Caucasians (34% and 21% increase, respectively).
Conclusions:
Individuals who had hip symptoms without hip rOA had an increased risk of mortality. These effects were particularly strong for those who were <65 years of age and Caucasians. Effective interventions to identify those with hip pain in order to lessen it could reduce premature mortality.
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