Objective It is uncertain whether persons with chronic widespread pain (CWP) experience premature mortality. Using the largest study conducted, we determine whether such a relationship exists, estimate its magnitude and establish what factors mediate any relationship.
Methods UK Biobank, a cohort study of 0.5 million people aged 40–69 years, recruited throughout Great Britain in 2006–2010. Participants reporting ‘pain all over the body’ for >3 months were compared with persons without chronic pain. Information on death (with cause) was available until mid-2015. We incorporated these results in a meta-analysis with other published reports to calculate a pooled estimate of excess risk.
Results 7130 participants reported CWP and they experienced excess mortality (mortality risk ratio 2.43, 95%CI 2.17 to 2.72). Specific causes of death in excess were cancer (1.73adjusted age and sex, 95% CI 1.46 to 2.05), cardiovascular (3.24adjusted age and sex, 95% CI 2.55 to 4.11), respiratory (5.66adjusted age and sex, 95% CI 4.00 to 8.03) and other disease-related causes (4.04adjusted age and sex, 95% CI 3.05 to 5.34). Excess risk was substantially reduced after adjustment for low levels of physical activity, high body mass index, poor quality diet and smoking. In meta-analysis, all studies showed significant excess all-cause (combined estimate 1.59 (95% CI 1.05 to 2.42)), cardiovascular and cancer mortality.
Conclusions Evidence is now clear that persons with CWP experience excess mortality. UK Biobank results considerably reduce uncertainty around the magnitude of excess risk and are consistent with the excess being explained by adverse lifestyle factors, which could be targeted in the management of such patients.
- fibromyalgis/Pain syndromes
- outcomes research
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Contributors GJM had the idea for the study and together with GTJ designed the analysis plan for UK Biobank. GTJ undertook the UK Biobank analysis. MSB conducted the updated systematic review, and all authors participated in undertaking the meta-analysis. GJM drafted the manuscript, but all authors made an important intellectual contribution to the text.
Competing interests None declared.
Ethics approval North West Multi-centre Research Ethics Committee (MREC).
Provenance and peer review Not commissioned; externally peer reviewed.
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