Comorbidity phenotypes and risk of mortality in patients with osteoarthritis in the UK: a latent class analysis

Abstract

Background: Osteoarthritis (OA) is a common chronic condition but its association with other chronic conditions and mortality is largely unknown. This study aimed to use latent class analysis (LCA) of 30 comorbidities in patients with OA and matched controls without OA to identify clusters of comorbidities and examine the associations between the clusters, opioid use, and mortality.

Methods: A matched cohort analysis of patients derived from the IQVIA Medical Research Data (IMRD-UK) database between 2000 and 2019. 418,329 patients with newly diagnosed OA were matched to 243,170 patients without OA to identify comorbidity phenotypes. Further analysis investigated the effect of opioid use on mortality in individuals with OA and their matched controls.

Results: The median (interquartile range (IQR)) number of comorbidities was 2 (1-4) and 1 (0-3) in the OA and control groups respectively. LCA identified six comorbidity phenotypes in individuals with and without OA. Clusters with a high prevalence of comorbidities were characterised by hypertension, circulatory, and metabolic diseases. We identified a comorbidity cluster with the aforementioned comorbidities plus a high prevalence of chronic kidney disease, which was associated with twice the hazard of mortality in hand OA with a hazard ratio (HR) (95% CI) of 2.53 (2.05-3.13) compared to the hazard observed in hip/knee OA subtype 1.33 (1.24-1.42). The impact of opioid use in the first 12 months on hazards of mortality was significantly greater for weak opioids and strong opioids across all groups HR (95% CI) ranging from 1.11 (1.07-11.6) to 1.80 (1.69-1.92)). There was however no evidence of association between NSAID use and altered risk of mortality.

Conclusion: This study identified six comorbidity clusters in individuals with OA and matched controls within this cohort. Opioid use and comorbidity clusters were differentially associated with the risk of mortality. The analyses may help shape the development of future interventions or health services that take into account the impact of these comorbidity clusters.

Keywords: Comorbidity; Electronic health records; Latent class analysis; Osteoarthritis; Primary care.

Fig. 1

Prevalence of individual (groups of) diseases in the overall OA and matched control population according to comorbidity phenotype at the time of diagnosis of OA

Fig. 2

Prevalence of individual (groups of) diseases in the hip/knee OA and hand OA population according to comorbidity phenotype at the time of diagnosis of OA

Fig. 3

Age- and sex-adjusted Kaplan-Meier survival curves according to comorbidity phenotypes by OA type and in the control population

Fig. 4

The effect of opioid use on mortality stratified by OA type and in the control population. Models were adjusted for comorbidity phenotypes, age, sex, BMI categories, deprivation quintiles, smoking status, and ethnicity