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Long-term mortality in older adults with chronic pain: a nationwide population-based study in Taiwan

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Key summary points

AbstractSection Aim

There is no clear information regarding the long-term mortality in the older population with chronic pain (CP), and therefore, we conducted this study to clarify it.

AbstractSection Findings

Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP.

AbstractSection Message

Early detection and intervention for treating CP are suggested for this population.

Abstract

Purpose

This study was conducted to clarify the long-term mortality in the older population with chronic pain (CP), which is still unclear.

Methods

We identified 17,568 older participants (aged ≥ 65 years) with CP and an identical number of comparison cohort without CP matched 1:1 by age and sex between 1996 and 2000 from the Taiwan National Health Insurance Research Database. Causes of CP, underlying comorbidities, living areas, and mortality were collected for analyses. The long-term mortality and the causes of mortality were compared between the two cohorts through follow-up since 2000 until 2015.

Results

The mean age (± standard deviation) was 73.5 ± 5.7 years, and female participants comprised 55.1% in both cohorts. The most common causes of CP were osteoarthritis (24.2%), spinal disorders (22.4%), peripheral vascular diseases (14.0%), and osteoporosis (9.5%). Older participants with CP had an increased rate of long-term mortality compared to that among their counterparts without CP after adjusting for the underlying comorbidities and the causes of CP (adjusted hazard ratio [AHR]: 1.18; 95% confidence interval [CI] 1.14–1.21). The increased mortality rate was observed even after the follow-up of 6 years (AHR 1.15; 95% CI 1.10–1.20). No significant difference was observed in the causes of mortality between the two cohorts. The most common cause of mortality was malignancy, followed by cardiovascular and cerebrovascular diseases.

Conclusions

Chronic pain was associated with an increased rate of long-term mortality in the older population. Early detection and intervention for treating CP are suggested for this population.

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Data availability

Data are available from the National Health Insurance Research Database (NHIRD) published by Taiwan National Health Insurance (NHI) Bureau. Due to legal restrictions imposed by the government of Taiwan in relation to the “Personal Information Protection Act”, data cannot be made publicly available. Requests for data can be sent as a formal proposal to the NHIRD (http://nhird.nhri.org.tw).

Abbreviations

CP:

Chronic pain

LHID:

Longitudinal Health Insurance Database

NHIRD:

National Health Insurance Research Database

NSAIDs:

Nonsteroidal anti-inflammatory drugs

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

AHR:

Adjusted hazard ratio

CI:

Confidence interval

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Funding

This study was supported by the Grant NHRINHIRD-99182 from the National Health Research Institutes in Taiwan and NSC 102-2314-B-384-001 from Taiwan National Science Council.

Author information

Author notes

  1. Jhi-Joung Wang and Chien-Cheng Huang contributed equally.

Authors and Affiliations

  1. Palliative Care Center, Chi-Mei Medical Center, Tainan, Taiwan

    Meng-Hsiu Tsai

  2. Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

    Meng-Hsiu Tsai

  3. Division of Controlled Drugs, Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan

    Wen-Ing Tsay & Shwu-Huey Her

  4. Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan

    Chung-Han Ho, Yi-Chen Chen & Jhi-Joung Wang

  5. Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

    Chung-Han Ho

  6. Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan

    Chien-Chin Hsu & Chien-Cheng Huang

  7. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Chien-Chin Hsu

  8. Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Jhi-Joung Wang

  9. Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Chien-Cheng Huang

  10. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chien-Cheng Huang

Authors
  1. Meng-Hsiu Tsai
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  2. Wen-Ing Tsay
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Contributions

MHT, CCH, and JJW designed and conceived this study and wrote the manuscript. CHH and YCC performed the statistical analysis and wrote the manuscript. WIT, SHH, and CCH provided professional suggestions and wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chien-Cheng Huang.

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Conflict of interest

The authors declare that they have no competing interests.

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Not applicable.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board at Chi-Mei Medical Center.

Informed consent

Since the data of the NHIRD have been identified, the informed consent was waived. The waiver does not affect the rights and welfare of the participants.

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Tsai, MH., Tsay, WI., Her, SH. et al. Long-term mortality in older adults with chronic pain: a nationwide population-based study in Taiwan. Eur Geriatr Med 10, 777–784 (2019). https://doi.org/10.1007/s41999-019-00228-7

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  • DOI: https://doi.org/10.1007/s41999-019-00228-7

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