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. 2021 Nov 14:42:101202.
doi: 10.1016/j.eclinm.2021.101202. eCollection 2021 Dec.

Association of chronic musculoskeletal pain with mortality among UK adults: A population-based cohort study with mediation analysis

Lingxiao Chen  1 , Manuela L Ferreira  1 , Natasha Nassar  2 , David B Preen  3 , John L Hopper  4 , Shuai Li  4   5   6 , Minh Bui  4 , Paula R Beckenkamp  7 , Baoyi Shi  8 , Nigel K Arden  9 , Paulo H Ferreira  7
Affiliations

Association of chronic musculoskeletal pain with mortality among UK adults: A population-based cohort study with mediation analysis

Lingxiao Chen et al. EClinicalMedicine. .

Abstract

Background: We aimed to quantify the association between chronic musculoskeletal pain and all-cause mortality, and to investigate the extent to which this association is mediated by physical activity, smoking status, alcohol consumption, and opioid use.

Methods: For this population-based cohort study, we used data from UK Biobank, UK between baseline visit (2006-2010) to 18th December 2020. We assessed the associations between chronic musculoskeletal pain and all-cause mortality using a Cox proportional hazards model. We performed causal mediation analyses to examine the proportion of the association between chronic musculoskeletal pain and all-cause mortality.

Findings: Of the 384,367 included participants, a total of 187,269 participants reported chronic musculoskeletal pain. Higher number of pain sites was associated with increased risk of all-cause mortality compared to having no pain (e.g., four sites vs no site of pain, Hazard Ratio [HR] 1.46, 95% Confidence Interval [CI] 1.35 to 1.57). The multiple mediator analyses showed that the mediating proportions of all four mediators ranged from 53.4% to 122.6%: among participants with two or more pain sites, the effect estimate reduced substantially, for example, HR reduced from 1.25 (95% CI: 1.21 to 1.30; two pain sites) to 1.07 (95% CI: 1.01 to 1.11; two pain sites).

Interpretation: We found that higher number of pain sites was associated with increased risk of all-cause mortality compared to having no pain, and at least half of the association of chronic musculoskeletal pain with increased all-cause mortality may be accounted for by four mediators.

Funding: Twins Research Australia.

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Conflict of interest statement

Dr Arden reported receiving personal fees from Pfizer/Lilly and Bristows LLP and grants from Merck outside the submitted work. Dr Nassar is supported by Financial Markets for Children and NHMRC. No other disclosures were reported.

Figures

Fig 1
Fig. 1
Flow chart. The reasons for ineligibility and the numbers of ineligible participants were shown on the right arrow. The numbers of potential eligible participants were connected through the down arrow.
See this image and copyright information in PMC

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