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All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study

BMJ 2011; 342 doi: (Published 08 March 2011) Cite this as: BMJ 2011;342:d1165
  1. Eveline Nüesch, research fellow12,
  2. Paul Dieppe, professor of clinical education research3,
  3. Stephan Reichenbach, rheumatologist and senior research fellow14,
  4. Susan Williams, research associate5,
  5. Samuel Iff, research fellow12,
  6. Peter Jüni, professor of clinical epidemiology12
  1. 1Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
  2. 2CTU Bern, Bern University Hospital, Bern
  3. 3Institute of Clinical Education, Peninsula Medical School, Universities of Exeter and Plymouth, UK
  4. 4Department of Rheumatology, Clinical Immunology and Allergology, Bern University Hospital
  5. 5Department of Social Medicine, University of Bristol, Bristol, UK
  1. Correspondence to: P Jüni juni{at}
  • Accepted 17 January 2011


Objective To examine all cause and disease specific mortality in patients with osteoarthritis of the knee or hip.

Design Population based cohort study.

Setting General practices in the southwest of England.

Participants 1163 patients aged 35 years or over with symptoms and radiological confirmation of osteoarthritis of the knee or hip.

Main outcome measures Age and sex standardised mortality ratios and multivariable hazard ratios of death after a median of 14 years’ follow-up.

Results Patients with osteoarthritis had excess all cause mortality compared with the general population (standardised mortality ratio 1.55, 95% confidence interval 1.41 to 1.70). Excess mortality was observed for all disease specific causes of death but was particularly pronounced for cardiovascular (standardised mortality ratio 1.71, 1.49 to 1.98) and dementia associated mortality (1.99, 1.22 to 3.25). Mortality increased with increasing age (P for trend <0.001), male sex (adjusted hazard ratio 1.59, 1.30 to 1.96), self reported history of diabetes (1.95, 1.31 to 2.90), cancer (2.28, 1.50 to 3.47), cardiovascular disease (1.38, 1.12 to 1.71), and walking disability (1.48, 1.17 to 1.86). However, little evidence existed for increased mortality associated with previous joint replacement, obesity, depression, chronic inflammatory disease, eye disease, or presence of pain at baseline. The more severe the walking disability, the higher was the risk of death (P for trend <0.001).

Conclusion Patients with osteoarthritis are at higher risk of death compared with the general population. History of diabetes, cancer, or cardiovascular disease and the presence of walking disability are major risk factors. Management of patients with osteoarthritis and walking disability should focus on effective treatment of cardiovascular risk factors and comorbidities, as well as on increasing physical activity.


  • We thank all study participants and the partners and staff of participating general practices for their support and interest in the study. We are indebted to the whole of the Somerset and Avon Survey of Health Research Team: Kirsty Alchin, Ros Berkeley-Hill, Jane Brooks, Hilary Brownett, Phil Chan, Clare Cross, Catherine Dawe, Cathy Doel, Jenny Eachus, Helen Forward, Matthew Grainge, Fiona Hollyman, Sue Jones, Helen Moore, Kate Morris, Nicky Pearson, Brian Quilty, Chris Smith, Lynne Smith, Gwyn Williams, Mark Williams, and Andrea Wilson; and to Allan Douglas and Doreen Cook at Dillon Computing. Finally, we thank our co-investigators, Jenny Donovan, Tim Peters, and Stephen Frankel. The Department of Social Medicine is the lead centre for the MRC Health Services Research Collaboration. We are grateful to Pete Shiarly for the management and maintenance of the database.

  • Contributors: PJ and PD had the idea for the study and were primarily responsible for developing the protocol. PD, SR, SW, and PJ contributed to data collection. EN did the data preparation and analysis. All authors reviewed the protocol and participated in interpretation of data. EN, PD, and PJ wrote the first draft of the paper, and all authors contributed to the final draft. PJ and PD are the guarantors.

  • Funding: The Somerset and Avon Survey of Health was originally funded by the Department of Health and the South and West NHS Research and Development Directorate. This work was funded by the Swiss National Science Foundation (grant numbers 3233-066377 and 3200-066378) and by Arthritis Research UK. The funding bodies had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was reviewed and approved by the relevant local research ethics committees, and all participants provided written informed consent.

  • Data sharing: No additional data are available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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