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Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung\u2013Knapp modification for random-effects meta-analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Findings<\/jats:title>\n                <jats:p>10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>Participants with POA or PROA had a 35\u201337% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Funding<\/jats:title>\n                <jats:p>Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40520-020-01762-2","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T21:53:52Z","timestamp":1613685232000},"page":"529-545","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Knee osteoarthritis and time-to all-cause mortality in six community-based cohorts: an international meta-analysis of individual participant-level data"],"prefix":"10.1007","volume":"33","author":[{"given":"Kirsten 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Dr Gates is funded by the Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis. Professor Arden reports grants from the Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, grants from Merck, and personal fees from Merck, Pfizer\/Lilly. Professor Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB. Professor Hunter reports personal fees from Merck Serono, Pfizer, Lilly, and TLCBio. Professor Jordan reports grants from National Institutes of Health, Centers for Disease Control and Prevention, American College of Rheumatology, personal fees from Samumed, Flexion, Osteoarthritis Research Society International, and National Institutes of Health. Professor Judge reports personal fees from Anthera Pharmaceuticals Ltd, Freshfields, Bruckhaus, and Derringer. Professor Jones reports personal fees from BMS, Roche, Abbvie, Amgen, Lilly, Novartis, Jannsen, and grants from Covance. Professor Felson has nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in each original cohort study were in accordance with the ethical standards of the institution and the associated national research committee.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statement of human and animal rights"}},{"value":"All participants provided written informed consent to participate in each original cohort study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}