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Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

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Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis : a study of 5658 UK Biobank participants. / McQueenie, Ross; Nicholl, Barbara I; Jani, Bhautesh Dinesh; Canning, Jordan; Macdonald, Sara; McCowan, Colin; Neary, Joanne; Browne, Susan; Mair, Frances S; Siebert, Stefan.

In: BMJ Open, Vol. 10, No. 11, e038829, 23.11.2020.

Research output: Contribution to journalArticlepeer-review

Harvard

McQueenie, R, Nicholl, BI, Jani, BD, Canning, J, Macdonald, S, McCowan, C, Neary, J, Browne, S, Mair, FS & Siebert, S 2020, 'Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants', BMJ Open, vol. 10, no. 11, e038829. https://doi.org/10.1136/bmjopen-2020-038829

APA

McQueenie, R., Nicholl, B. I., Jani, B. D., Canning, J., Macdonald, S., McCowan, C., Neary, J., Browne, S., Mair, F. S., & Siebert, S. (2020). Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants. BMJ Open, 10(11), [e038829]. https://doi.org/10.1136/bmjopen-2020-038829

Vancouver

McQueenie R, Nicholl BI, Jani BD, Canning J, Macdonald S, McCowan C et al. Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants. BMJ Open. 2020 Nov 23;10(11). e038829. https://doi.org/10.1136/bmjopen-2020-038829

Author

McQueenie, Ross ; Nicholl, Barbara I ; Jani, Bhautesh Dinesh ; Canning, Jordan ; Macdonald, Sara ; McCowan, Colin ; Neary, Joanne ; Browne, Susan ; Mair, Frances S ; Siebert, Stefan. / Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis : a study of 5658 UK Biobank participants. In: BMJ Open. 2020 ; Vol. 10, No. 11.

Bibtex - Download

@article{46657d8fb89e4ce5815d6ec52eb3a041,
title = "Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants",
abstract = "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{\textquoteright}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.",
author = "Ross McQueenie and Nicholl, {Barbara I} and Jani, {Bhautesh Dinesh} and Jordan Canning and Sara Macdonald and Colin McCowan and Joanne Neary and Susan Browne and Mair, {Frances S} and Stefan Siebert",
note = "Funding: This study was funded by Versus Arthritis (grant number 21970).",
year = "2020",
month = nov,
day = "23",
doi = "10.1136/bmjopen-2020-038829",
language = "English",
volume = "10",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group Ltd",
number = "11",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis

T2 - a study of 5658 UK Biobank participants

AU - McQueenie, Ross

AU - Nicholl, Barbara I

AU - Jani, Bhautesh Dinesh

AU - Canning, Jordan

AU - Macdonald, Sara

AU - McCowan, Colin

AU - Neary, Joanne

AU - Browne, Susan

AU - Mair, Frances S

AU - Siebert, Stefan

N1 - Funding: This study was funded by Versus Arthritis (grant number 21970).

PY - 2020/11/23

Y1 - 2020/11/23

N2 - 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.

AB - 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.

U2 - 10.1136/bmjopen-2020-038829

DO - 10.1136/bmjopen-2020-038829

M3 - Article

VL - 10

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 11

M1 - e038829

ER -

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