Lower education linked to higher mortality in patients with osteoarthritis
Click Here to Manage Email Alerts
Lower education is associated with higher all-cause and cause-specific mortality, as well as a greater burden of cardiovascular diseases, in patients with osteoarthritis, according to data published in Arthritis Care & Research.
“There is a well-known association between socioeconomic status (SES) and health, where people with lower SES generally tend to have poorer health and increased mortality,” Maria Lindéus, MD, of Lund University and Skåne University Hospital, in Sweden, and colleagues wrote. “In the OA context, previous studies have reported an inverse association between both individual and area-level SES and OA prevalence. However, no previous study has, to our knowledge, examined the association between SES and all-cause and cause-specific mortality among patients with OA.”
“Considering that no widely accepted disease-modifying drug is on the market for OA treatment, understanding societal factors associated with adverse consequences of the disease is important,” they added. “Education is an important factor to consider in OA management since several studies have reported an inverse association between educational attainment and prevalence/symptoms of OA.”
To analyze the association between education all-cause and cause-specific mortality among patients with OA, compared with those without the disease, Lindéus and colleagues conducted a register-based open cohort study using data from the Skåne health care register. According to the researchers, the register includes information on all health care consultations in the Skåne region of Sweden. Lindéus and colleagues identified and included 123,993 residents aged 45 years and older who were diagnosed with OA of the peripheral joints between 1998 and 2013, and had education information in their analysis.
The researchers also included a total of 121,218 individuals without OA in their reference cohort. Lindéus and colleagues followed these patients until death, relocation to outside Skåne or the end of 2014. They then estimated the relative index of inequality (RII) and the slope index of inequality (SII), using the Cox model and Aalen’s additive hazard model, respectively.
According to the researchers, the magnitude of relative inequalities in all‐cause mortality were comparable in both the OA (RII = 1.53; 95% CI,1.46-1.61) and reference cohorts (RII = 1.54; 95% CI,1.47-1.62). Meanwhile, absolute inequalities were smaller in patients with OA, with an SII of 937 all‐cause deaths per 100,000 person‐years (95% CI, 811-1,063), compared with an SII of 1,265 (95% CI, 1,109-1,421) in those without.
Cardiovascular mortality accounted for 60.1% of absolute inequalities in patients with OA, compared with 48.1% in the reference cohort, while the opposite was observed for cancer mortality — 8.5% compared with 22.3%.
“We found an inverse association between educational attainment and all-cause and cause specific mortality among OA patients,” Lindéus and colleagues wrote. “The educational inequalities seen in the OA cohort were also seen in the reference cohort, indicating that the inequalities in the OA cohort reflect inequalities in the population at large. Hence, these inequalities should primarily be addressed in the general population in order to even out the observed disparities among both people with and without OA.”
“However, our estimates also indicate a greater burden of cardiovascular diseases in OA patients compared to the reference cohort,” they added. “The greater burden of cardiovascular diseases applies particularly to OA patients with low education. This finding generates an opportunity to reduce educational inequalities in cardiovascular mortality in OA patients, by focusing on prevention and treatment of cardiovascular risk factors in OA patients.”
Collapse
Read more about
Click Here to Manage Email Alerts