Mortality and cancer in patients with new musculoskeletal episodes: a cohort study.

BACKGROUND The risk of serious outcome in persons presenting to primary care with common regional musculoskeletal problems is unknown. AIM To determine the risk of mortality and cancer in older patients presenting with new musculoskeletal problems. DESIGN OF STUDY Cohort study. SETTING One hundred and seventy-nine general practices contributing to the General Practice Research Database. METHOD Cases were 48,206 people aged > or =50 years, with a recorded musculoskeletal problem in 1996 but none during the previous 2 years. Cases were allocated to groups based on problem location (for example, the back). A total of 40,254 controls had no musculoskeletal consultation during 1996 or during the previous 2 years. Outcome measures were mortality and recorded malignant and pre-malignant neoplasms 1 and 10 years after baseline consultation. RESULTS Mortality rates in the first year of follow-up were higher for cases (373 per 10,000 person-years) than controls (244). The hip (standardised mortality ratio 2.36; 95% confidence interval [CI] = 1.99 to 2.77 compared to controls) and back (2.07; 95% CI = 1.87 to 2.28) groups had the highest 1-year rates. Ten-year mortality rates were closer between groups. Higher cancer rates were found for the back, hip, and neck groups. The first-year excess mortality in cases was only partly explained by cancer and other comorbidity (hip hazard ratio 1.72; 95% CI = 1.43 to 2.07; back 1.68; 95% CI = 1.49 to 1.90). CONCLUSION New consulting episodes of musculoskeletal problems in the back or hip are associated with higher subsequent cancer rates and increased mortality risk in older people. Unexpected cancer and death in these patients remains rare but the ability of clinical signs and symptoms to identify persons at risk needs to be confirmed.