{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T18:41:03Z","timestamp":1774291263799,"version":"3.50.1"},"reference-count":48,"publisher":"BMJ","issue":"2","funder":[{"name":"National Institute for Health Research (NIHR) and Health Education England","award":["ICA-CL-2016-014"],"award-info":[{"award-number":["ICA-CL-2016-014"]}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["G9900220"],"award-info":[{"award-number":["G9900220"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2019,10,23]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To identify potentially modifiable factors that mediate the association between symptomatic osteoarthritis (OA) and premature mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A population-based prospective cohort study; primary care medical record data were linked to self-report information collected by questionnaire in adults aged 50 years and over (n=10\u2009415). OA was defined by primary care consultation and moderate-to-severe pain interference in daily life. A Cox proportional hazards analysis determined the total effect (TE) of OA on mortality after adjustment for potential confounders. Within the Cox model, path analysis was used to decompose the TE to assess the indirect and direct effects for selected potential mediators (anxiety, depression, unrefreshed sleep and walking frequency). Results are expressed as HRs with 95% CIs derived from bootstrap resampling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>OA was significantly associated with mortality (TE-adjusted HR 1.14; 95%\u2009CI 1.00 to 1.29). The indirect effects for walking frequency were 1.05 (95% CI 1.04 to 1.06), depression 1.02 (95% CI 1.02 to 1.03), anxiety 1.01 (95% CI 1.00 to 1.02) and unrefreshed sleep 1.01 (95% CI 1.00 to 1.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The analysis indicates that encouraging people to walk and \u2018get out and about\u2019 in addition to targeting OA could be protective against excessive mortality. The findings also suggest that depression, anxiety and unrefreshed sleep have a role in premature mortality for people with OA; however, this has low clinical significance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2019-001048","type":"journal-article","created":{"date-parts":[[2019,11,14]],"date-time":"2019-11-14T05:35:13Z","timestamp":1573709713000},"page":"e001048","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Reasons why osteoarthritis predicts mortality: path analysis within a Cox proportional hazards model"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4825-714X","authenticated-orcid":false,"given":"Ross","family":"Wilkie","sequence":"first","affiliation":[{"name":"Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simran Singh","family":"Parmar","sequence":"additional","affiliation":[{"name":"Keele Medical School, Keele University, Keele, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7230-7771","authenticated-orcid":false,"given":"Milica","family":"Blagojevic-Bucknall","sequence":"additional","affiliation":[{"name":"Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Smith","sequence":"additional","affiliation":[{"name":"Manchester Metropolitan University, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin J","family":"Thomas","sequence":"additional","affiliation":[{"name":"Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bethany Jane","family":"Seale","sequence":"additional","affiliation":[{"name":"Keele Medical School, Keele University, Keele, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Mansell","sequence":"additional","affiliation":[{"name":"Department of Psychology, Aston University, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Peat","sequence":"additional","affiliation":[{"name":"Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,13]]},"reference":[{"key":"2025090312522092000_5.2.e001048.1","doi-asserted-by":"publisher","DOI":"10.18043\/ncm.78.5.322"},{"key":"2025090312522092000_5.2.e001048.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31460-X"},{"key":"2025090312522092000_5.2.e001048.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0091286","article-title":"All-Cause mortality and serious cardiovascular events in people with hip and knee osteoarthritis: a population based cohort study","volume":"9","author":"Hawker","year":"2014","journal-title":"PLoS One"},{"key":"2025090312522092000_5.2.e001048.4","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.semarthrit.2016.04.002","article-title":"Osteoarthritis and mortality: a prospective cohort study and systematic review with meta-analysis","volume":"46","author":"Veronese","year":"2016","journal-title":"Semin Arthritis Rheum"},{"key":"2025090312522092000_5.2.e001048.5","first-page":"1094","article-title":"Association between osteoarthritis and mortality: a meta-analysis","volume":"10","author":"Han","year":"2017","journal-title":"Int J Clin and Exp Med"},{"key":"2025090312522092000_5.2.e001048.6","doi-asserted-by":"crossref","DOI":"10.1038\/srep24393","article-title":"Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis","volume":"6","author":"Xing","year":"2016","journal-title":"Sci Rep"},{"key":"2025090312522092000_5.2.e001048.7","unstructured":"Osteoarthritis: A Serious Disease . 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