Persons with chronic widespread pain experience excess mortality: longitudinal results from UK Biobank and meta-analysis

Gary J MacFarlane* (Corresponding Author), Maxwell S Barnish, Gareth T Jones

*Corresponding author for this work

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Objective: It is uncertain whether persons with chronic widespread pain (CWP) experience premature mortality. Using the largest study conducted, we determine whether such a relationship exists, estimate its magnitude and establish what factors mediate any relationship. Methods: UK Biobank, a cohort study of 0.5 million people aged 40-69 years, recruited throughout Great Britain 2006-10. Participants reporting “pain all over the body” for >3 months were compared with persons without chronic pain.. Information on death (with cause) was available until mid-2015. We incorporated these results in a meta-analysis with other published reports to calculate a pooled estimate of excess risk.. Results: 7130 participants reported CWP and they experienced excess mortality (Mortality Risk Ratio 2.43, 95% Confidence Interval 2.17, 2.72). Specific causes of death in excess were cancer (1.73adjusted age and sex; 1.46, 2.05); cardiovascular (3.24adjusted age and sex; 2.55, 4.11); respiratory (5.66adjusted age and sex; 4.00, 8.03); and other disease-related causes (4.04adjusted age and sex; 3.05, 5.34). Excess risk was substantially reduced after adjustment for low levels of physical activity, high body mass index (BMI), poor quality diet and smoking. In meta-analysis, all studies showed significant excess all-cause ( combined estimate 1.59 (1.05, 2.42)). cardiovascular and cancer mortality. Conclusions: Evidence is now clear that persons with CWP experience excess mortality. UK Biobank results considerably reduce uncertainty around the magnitude of excess risk, and are consistent with the excess being explained by adverse lifestyle factors, which could be targeted in the management of such patients.
Original languageEnglish
Pages (from-to)1815-1822
Number of pages8
JournalAnnals of the Rheumatic Diseases
Issue number11
Early online date21 Jul 2017
Publication statusPublished - Nov 2017

Bibliographical note

This manuscript uses the UK Biobank resource (Application 1144). We acknowledge the authors of a previous meta-analysis on this topic (Diane Smith, Ross Wilkie, Olalekan Uthman, Joanne L. Jordan, John McBeth) whose published search strategy we used as the basis for our meta-analysis, albeit that our meta-analysis had a more restricted focus and the criteria for determining eligibility and the data we extracted from eligible studies was not identical and resulted in selection of a different group of studies. We thank John McBeth (University of Manchester) for providing additional data relating to one of the studies, to allow it be included in the meta-analysis. GJM had the idea for the study and together with GTJ designed the analysis plan for UK Biobank. GTJ undertook the UK Biobank analysis. MSB conducted the updated systematic review and all authors participated in undertaking the meta-analysis. GJM drafted the manuscript but all authors made an important intellectual contribution to the text. None of the authors report conflict of interest.


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