Pre-existing musculoskeletal pain and its association with mortality in newly diagnosed co-morbid conditions: an electronic health record cohort study

Objective Musculoskeletal pain is a common risk factor for co-morbid conditions and might increase the risk of poor outcomes. The objective was to determine whether patients with pre-existing musculoskeletal pain have an increased risk for mortality following a new diagnosis of a co-morbid condition.Methods Patients aged >= 45 years with a new diagnosis of acute coronary syndrome (ACS), stroke, cancer, dementia or pneumonia recorded in a UK electronic primary care database linked to hospital and mortality records were examined. The association of mortality with musculoskeletal pain (inflammatory conditions, OA and regional pain) was determined.Results The sample size varied from 128 649 (stroke) to 406 289 (cancer) by cohort, with 22-31% having pre-existing musculoskeletal conditions. In the ACS cohort, there was a higher rate of mortality for all musculoskeletal types. There were also higher unadjusted mortality rates in patients with inflammatory arthritis compared with those without musculoskeletal pain in the stroke, cancer and dementia cohorts and for patients with OA in the stroke and cancer cohorts. After adjustment for the number of prescribed medications and age, the increased risk of mortality remained only for patients with inflammatory arthritis in the ACS cohort (adjusted hazard ratio = 1.07; 95% CI 1.03, 1.10).Conclusion Older adults with inflammatory arthritis and OA have increased risk of mortality when they develop a new condition, which seems to be related to the prescription of multiple medicines. Pre-existing musculoskeletal pain is an indicator of a complex patient who is at risk of poorer outcomes at the onset of new illnesses. What does this mean for patients?Musculoskeletal pain (pain in the joints and muscles around them) is common, and those with pain often have other long-term conditions. We wanted to find out whether people with musculoskeletal pain have an increased risk of earlier death following diagnosis of a new serious illness. We studied anonymized health-care records of patients aged 45 years and over with a new diagnosis of heart attack, stroke, cancer, dementia or pneumonia. Approximately one-third of people with these new diagnoses had a musculoskeletal pain condition, such as inflammatory arthritis, osteoarthritis or regional (e.g. back, knee) pain. This group had an increased risk of earlier death compared with those without existing musculoskeletal pain, with the highest risk in those with inflammatory arthritis and osteoarthritis. However, this increased risk was explained by those with musculoskeletal pain being older and on many medications. Taking multiple medicines suggests that patients have more illnesses but increases the possibility of taking medicines with little benefit or that cause harm and the possibility of not taking medicines as instructed. Doctors need to consider all of a patient's current illnesses and medicines when treating a new illness. Improving musculoskeletal pain recognition and management, and regular medicine reviews, might help to improve the outcomes of other illnesses.