Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study

McLoone, P. , Jani, B. D. , Siebert, S. , Morton, F. R. , Canning, J., Macdonald, S. , Mair, F. S. and Nicholl, B. I. (2023) Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study. Journal of Multimorbidity and Comorbidity, 13, p. 26335565221148616. (doi: 10.1177/26335565221148616) (PMID:36798088) (PMCID:PMC9926377)

Abstract

Purpose: We aimed to classify individuals with RA and ≥2 additional long-term conditions (LTCs) and describe the association between different LTC classes, number of LTCs and adverse health outcomes. Methods: We used UK Biobank participants who reported RA (n=5,625) and employed latent class analysis (LCA) to create classes of LTC combinations for those with ≥2 additional LTCs. Cox-proportional hazard and negative binomial regression were used to compare the risk of all-cause mortality, major adverse cardiac events (MACE), and number of emergency hospitalisations over an 11-year follow-up across the different LTC classes and in those with RA plus one additional LTC. Persons with RA without LTCs were the reference group. Analyses were adjusted for demographic characteristics, smoking, BMI, alcohol consumption and physical activity. Results: A total of 2,566 (46%) participants reported ≥2 LTCs in addition to RA. This involved 1,138 distinct LTC combinations of which 86% were reported by ≤2 individuals. LCA identified 5 morbidity-classes. The distinctive condition in the class with the highest mortality was cancer (class 5; HR 2.66 95%CI (1.91-3.70)). The highest MACE (HR 2.95 95%CI (2.11-4.14)) and emergency hospitalisations (rate ratio 3.01 (2.56-3.54)) were observed in class 3 which comprised asthma, COPD & CHD. There was an increase in mortality, MACE and emergency hospital admissions within each class as the number of LTCs increased. Conclusions: The risk of adverse health outcomes in RA varied with different patterns of multimorbidity. The pattern of multimorbidity should be considered in risk assessment and formulating management plans in patients with RA.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jani, Dr Bhautesh and McLoone, Mr Philip and Siebert, Professor Stefan and Morton, Mr Fraser and Mair, Professor Frances and Nicholl, Dr Barbara and Canning, Jordan and Macdonald, Professor Sara
• Authors: McLoone, P., Jani, B. D., Siebert, S., Morton, F. R., Canning, J., Macdonald, S., Mair, F. S., and Nicholl, B. I.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: Journal of Multimorbidity and Comorbidity
• Publisher: SAGE Publications
• ISSN: 2633-5565
• ISSN (Online): 2633-5565
• Published Online: 10 February 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Journal of Multimorbidity and Comorbidity 13: 26335565221148616
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
301668		Multimorbidity in Arthritis and persistent musculoskeletal Pain (MAP) Study	Barbara Nicholl	Versus Arthritis (ARTRESUK)	Ref: 21970	HW - General Practice and Primary Care