Clinical Rheumatology

, Volume 38, Issue 11, pp 3253–3259 | Cite as

Does symptomatic knee osteoarthritis increase the risk of all-cause mortality? Data from four international population-based longitudinal surveys of aging

  • Zidan Yang
  • Guanghua Lei
  • Xiaoxiao Li
  • Yilun Wang
  • Zikun Xie
  • Xiurui Zhang
  • Yuchen He
  • Yilin XiongEmail author
  • Tubao YangEmail author
Original Article



This study aimed at examining the association between symptomatic knee osteoarthritis and all-cause mortality based on four population-based longitudinal surveys.


Data were retrieved from the English Longitudinal Study of Aging (ELSA), the Survey of Health, Aging and Retirement in Europe (SHARE), the Korean Longitudinal Study of Aging (KLoSA), and the Indonesian Family Life Survey (IFLS). The association between symptomatic knee osteoarthritis and all-cause mortality over the 8- to 12-year follow-up period was assessed using Cox-proportional hazard models.


In the entire sample of 59,522 participants (4823 with symptomatic knee osteoarthritis; 54,699 without symptomatic knee osteoarthritis [control group]; mean age: 61.8 years; female percentage: 55.3%), 8375 died (937 in the symptomatic knee osteoarthritis group, 7438 in the control group) during the follow-up period. Patients with symptomatic knee osteoarthritis had a higher risk of all-cause mortality than control group without adjusting for potential confounders in each survey, and the unadjusted hazard ratios (HRs) of all-cause mortality were 1.32 (95% confidence interval [CI] 1.18 to 1.47) in ELSA, 1.40 (95%CI 1.24 to 1.56) in SHARE, 1.25 (95%CI 1.06 to 1.47) in KLoSA, and 1.65 (95%CI 1.31 to 2.07) in IFLS. However, with adjustment of potential confounders, the corresponding HRs dropped to 1.07 (95%CI 0.94 to 1.20) in ELSA, 1.08 (95%CI 0.97 to 1.22) in SHARE, 0.91 (95%CI 0.77 to 1.08) in KLoSA, and 0.89 (95%CI 0.66 to 1.21) in IFLS, respectively.


In these four population-based longitudinal studies, no association between symptomatic knee osteoarthritis and increased risk of all-cause mortality was observed after adjusting for potential confounders.

Key Points

• This study evaluated the association between symptomatic knee OA and the risk of all-cause mortality among the participants retrieved from four large population-based longitudinal studies across the world.

• No association between symptomatic knee osteoarthritis and increased risk of all-cause mortality was observed after considering potential confounders, and our findings were consistent with the results derived from four independent longitudinal studies.

• The present study included four international population-based longitudinal studies, comprising both developed and developing areas, which allowed the findings to be interpreted under larger circumstance.


Knee Longitudinal studies Mortality Osteoarthritis 



The authors appreciate the support of Hunan Key Laboratory of Joint Degeneration and Injury and Hunan Engineering Research Center of Osteoarthritis.

Authors’ contributions

YX and TY are joint corresponding authors. ZY, YX, and TY conceived the study. ZY, YX, and TY were responsible for conception of the study and drafted the manuscript. GL, YX, and TY were responsible for design of the study. XL, ZX, XZ, YH, contributed to preparation and data analysis. YW, TY, YX, and GL contributed to revision of the manuscript. All the authors contributed to the interpretation of the data and critically reviewed the manuscript for publication. All authors read and approved the final manuscript.

Funding information

This work was funded by the Fundamental Research Funds for the Central Universities of Central South University (2019zzts747); the National Natural Science Foundation of China (81601941, 81772413, 81702207, 81702206); the Key Research and Development Program of Hunan Province (2018SK2070, 2018SK2073); the Postdoctoral Science Foundation of Central South University (182130); the Young Investigator Grant of Xiangya Hospital, Central South University (2016Q03, 2016Q06); the Xiangya Clinical Big Data System Construction Project of Central South University (45); the Clinical Scientific Research Foundation of Xiangya Hospital, Central South University (2015L03); and the Natural Science Foundation of Hunan Province (2017JJ3491, 2017JJ3492).

Compliance with ethical standards

Ethical approval for all surveys were granted from the corresponding ethics committees: the Multicentre Research and Ethics Committee for ELSA, the Ethics Committee of the University of Mannheim for SHARE, the Seoul National University Hospital’s Institutional Review Board for KLoSA, and the ethics review boards of RAND and University of Gadjah Mada in Indonesia for IFLS. All participants provided written informed consent to participate in these surveys.



Supplementary material

10067_2019_4672_MOESM1_ESM.pdf (145 kb)
ESM 1 (PDF 145 kb)
10067_2019_4672_MOESM2_ESM.pdf (159 kb)
ESM 2 (PDF 159 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Health Statistics, Xiangya School of Public HealthCentral South UniversityChangshaChina
  2. 2.Hunan Key Laboratory of Joint Degeneration and InjuryChangshaChina
  3. 3.Department of Orthopaedics, Xiangya HospitalCentral South UniversityChangshaChina
  4. 4.National Clinical Research Center of Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaChina

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