Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants
Objective To investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).Design Population-based longitudinal cohort study.Setting UK Biobank.Participants UK Biobank participa...
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doaj-3391275f47a24b139031b4cba1a82f792021-06-25T12:37:34ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-038829Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participantsSara Macdonald0Ross McQueenie1Colin McCowan2Frances S Mair3Barbara I Nicholl4Bhautesh D Jani5Jordan Canning6Joanne Neary7Susan Browne81 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK 1 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK 3 School of Medicine, University of St. Andrews, Saint Andrews, UK 1 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK 1 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK 1 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK 1 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK1 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK 1 General Practice and Primary Care, Institute of Health and Wellbeing, MVLS, University of Glasgow, Glasgow, UK Objective To investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).Design Population-based longitudinal cohort study.Setting UK Biobank.Participants UK Biobank participants (n=502 533) aged between 37 and 73 years old.Primary outcome measures Primary outcome measures were risk of all-cause mortality and MACE.Methods We examined the relationship between LTC count and individual comorbid LTCs (n=42) on adverse clinical outcomes in participants with self-reported RA (n=5658). Risk of all-cause mortality and MACE were compared using Cox’s proportional hazard models adjusted for lifestyle factors (smoking, alcohol intake, physical activity), demographic factors (sex, age, socioeconomic status) and rheumatoid factor.Results 75.7% of participants with RA had multimorbidity and these individuals were at increased risk of all-cause mortality and MACE. RA and >4 LTCs showed a threefold increased risk of all-cause mortality (HR 3.30, 95% CI 2.61 to 4.16), and MACE (HR 3.45, 95% CI 2.66 to 4.49) compared with those without LTCs. Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in participants with RA compared with those without RA or LTCs: twofold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55 to 3.12) and threefold increased risk of MACE (HR 3.17, 95% CI 2.27 to 4.64). These findings remained in a subset (n=3683) with RA diagnosis validated from clinical records or medication reports.Conclusion Those with RA and other LTCs, particularly comorbid osteoporosis, are at increased risk of adverse outcomes, although the role of corticosteroids could not be evaluated in this study. These results are clinically relevant for the monitoring and management of RA across the healthcare system, and future clinical guidelines for RA should acknowledge the importance of multimorbidity.https://bmjopen.bmj.com/content/10/11/e038829.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sara Macdonald Ross McQueenie Colin McCowan Frances S Mair Barbara I Nicholl Bhautesh D Jani Jordan Canning Joanne Neary Susan Browne |
spellingShingle |
Sara Macdonald Ross McQueenie Colin McCowan Frances S Mair Barbara I Nicholl Bhautesh D Jani Jordan Canning Joanne Neary Susan Browne Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants BMJ Open |
author_facet |
Sara Macdonald Ross McQueenie Colin McCowan Frances S Mair Barbara I Nicholl Bhautesh D Jani Jordan Canning Joanne Neary Susan Browne |
author_sort |
Sara Macdonald |
title |
Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants |
title_short |
Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants |
title_full |
Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants |
title_fullStr |
Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants |
title_full_unstemmed |
Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants |
title_sort |
patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 uk biobank participants |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2020-11-01 |
description |
Objective To investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).Design Population-based longitudinal cohort study.Setting UK Biobank.Participants UK Biobank participants (n=502 533) aged between 37 and 73 years old.Primary outcome measures Primary outcome measures were risk of all-cause mortality and MACE.Methods We examined the relationship between LTC count and individual comorbid LTCs (n=42) on adverse clinical outcomes in participants with self-reported RA (n=5658). Risk of all-cause mortality and MACE were compared using Cox’s proportional hazard models adjusted for lifestyle factors (smoking, alcohol intake, physical activity), demographic factors (sex, age, socioeconomic status) and rheumatoid factor.Results 75.7% of participants with RA had multimorbidity and these individuals were at increased risk of all-cause mortality and MACE. RA and >4 LTCs showed a threefold increased risk of all-cause mortality (HR 3.30, 95% CI 2.61 to 4.16), and MACE (HR 3.45, 95% CI 2.66 to 4.49) compared with those without LTCs. Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in participants with RA compared with those without RA or LTCs: twofold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55 to 3.12) and threefold increased risk of MACE (HR 3.17, 95% CI 2.27 to 4.64). These findings remained in a subset (n=3683) with RA diagnosis validated from clinical records or medication reports.Conclusion Those with RA and other LTCs, particularly comorbid osteoporosis, are at increased risk of adverse outcomes, although the role of corticosteroids could not be evaluated in this study. These results are clinically relevant for the monitoring and management of RA across the healthcare system, and future clinical guidelines for RA should acknowledge the importance of multimorbidity. |
url |
https://bmjopen.bmj.com/content/10/11/e038829.full |
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