What are the effects of the comorbidity of chronic pain, cardiometabolic disease and depression on health outcomes? A UK Biobank cohort study

Conference:

SAPC ASM 2021 - virtual

Talk Code:

P1.11.8

Presenter:

Simin Wu

Twitter:

@Selina_Wu_

Co-authors:

Frances Mair, Sara Macdonald, Philip McLoone, Barbara Nicholl

Author institutions:

General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow

Problem

Chronic pain commonly co-occurs with cardiometabolic disease and depression. There is a lack of evidence regarding the implications of this combination of comorbidity. This study aimed to examine the prevalence of the comorbidity in the UK Biobank, and to examine the effect of the comorbidity on health outcomes (all-cause mortality) and Major Adverse Cardiovascular Events (MACE).

Approach

We identified people with the comorbidity of chronic pain, cardiometabolic disease (diabetes, hypertension, coronary heart disease, stroke/Transient Ischaemic Attack, atrial fibrillation, peripheral vascular disease, heart failure) and depression from the UK Biobank. Clinical outcomes were identified from linkage to national mortality registers and hospital episode statistics over a median follow-up time of approximately 11 years. Outcomes examined in the study included all-cause mortality and MACE. Cox-proportional hazards models were used to assess the association between the comorbidity (chronic pain, cardiometabolic disease and depression) and each outcome compared to participants in the cohort with no long term conditions (LTCs). The survival analysis was adjusted for demographic and lifestyle factors: age, gender, deprivation, ethnicity, smoking status, alcohol intake frequency, physical activities and BMI.

Findings

Among 500,313 eligible participants, 8,640 (1.73%) participants had the comorbidity which was associated with female gender, more deprivation, smoking, less physical activities and higher BMI. Participants aged between 55-59 years were at the most risk of having the comorbidity. People with this combination of comorbidity had 2.08 (95% CI: 1.82 – 2.39) times the risk of all-cause mortality compared to participants with no LTCs, after adjusting for confounders. Participants with the comorbidity also had 2.17 (95% CI: 1.84 – 2.57) times risk of MACE from the comorbidity compared to participants with no LTCs, after adjusting for confounders.

Consequences

The comorbidity of cardiometabolic disease, depression and chronic pain was common in this cohort, particularly women and more socioeconomically deprived. The combination of conditions was associated with increased risk of adverse health outcomes. Greater attention should be focused on the implications for management of people with this pattern of comorbidity.

Submitted by:

Selina Wu

Funding acknowledgement:

The research is part of the author's PhD programme, which is funded by the joint scholarship of the University of Glasgow and the China Scholarship Council.