Dataset Information

Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.

ABSTRACT:

Background

The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear.

Objective

To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability.

Design

Prospective cohort study.

Setting

The Study of Osteoporotic Fractures.

Participants

Women aged 65 or older.

Measurement

Our primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators.

Results

Of 8321 women (mean age 71.5, SD?=?5.1), 4975 (56%) died over a median follow-up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR]?=?1.24 [95% CI, 1.11-1.39]), cardiovascular (HR?=?1.34 [CI, 1.12-1.62]), and cancer (HR?=?1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p?LimitationsOnly white women were included.

Conclusion

Frequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.

SUBMITTER: Roseen EJ

PROVIDER: S-EPMC6318166 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.

Roseen Eric J EJ LaValley Michael P MP Li Shanshan S Saper Robert B RB Felson David T DT Fredman Lisa L

Journal of general internal medicine 20181022 1

<h4>Background</h4>The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear.<h4>Objective</h4>To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>The Study of Osteoporotic Fractures.<h4>Participants</h4>Women aged 65 or older.<h4>Measurement</h4>Our primary outcome, time to ...[more]

PMID: 30350028

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Project description:BackgroundThis study aimed to examine associations between haemoglobin A1c (HbA1c) levels over time and all-cause and cause-specific mortality in middle-aged and older Koreans.MethodsUsing 16 years of follow-up data from the Korean Genome and Epidemiology Study, we analysed 9294 individuals aged 40-69 years with no history of cardiovascular disease (CVD) or cancer. Participants were divided into a known diabetes group and five groups categorized by HbA1c levels (< 5.0%, 5.0-5.4%, 5.5-5.9%, 6.0-6.4%, and ≥ 6.5%). Hazard ratios (HRs) for all-cause and cause-specific mortality associated with HbA1c levels were calculated using a conventional and a time-dependent Cox proportional hazards model. Restricted cubic spline models were fitted to investigate the relationship between continuous HbA1c levels and mortality among people without known diabetes. Subgroup analyses were performed for age, sex, smoking, hypertension, liver diseases, and red blood cell counts.ResultsDuring a median follow-up period of 15.7 years, there were 944 deaths, including 185 deaths from CVD, 359 from cancer, and 125 from all external causes. Compared with participants with HbA1c levels of 5.5-5.9%, multivariate-adjusted HRs and 95% confidence intervals for all-cause death of participants with levels < 5.0%, 5.0-5.4%, 6.0-6.4%, and ≥ 6.5% and participants with known diabetes were 1.84 (1.35-2.51), 1.13 (0.95-1.34), 1.30 (1.04-1.62), 1.37 (0.97-1.93), and 2.03 (1.70-2.44), respectively. The risk of cancer mortality was significantly increased in HbA1c < 5.0% (HR, 2.21; 95% CI 1.42-3.44) and known diabetes (HR, 1.60; 95% CI 1.18-2.15). When we performed diverse subgroup analyses, low HbA1c levels at baseline were strongly associated with mortality in participants with liver diseases.ConclusionsWe found U-shaped associations between HbA1c levels at baseline and over time and all-cause mortality in middle-aged and older Koreans. Additionally, the risk of cancer mortality increased both in low and high HbA1c groups, but CVD mortality increased only in high HbA1c group. In particular, people with liver diseases and low HbA1c levels had a high risk of all-cause mortality. Therefore, more careful management of these groups is suggested to identify any deteriorating health conditions.

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Dataset Information

Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.

Background

Objective

Design

Setting

Participants

Measurement

Results

Conclusion

Publications

Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study.

Similar Datasets

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