| 1. |
- Turkiewicz, Aleksandra, et al.
(author)
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All-cause mortality in knee and hip osteoarthritis and rheumatoid arthritis
- 2016
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In: Epidemiology. - 1044-3983. ; 27:4, s. 479-485
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Journal article (peer-reviewed)abstract
- BACKGROUND:: While increased mortality in rheumatoid arthritis (RA) is well established there is conflicting evidence on the association between osteoarthritis (OA) and mortality. Our aim was to estimate all-cause mortality in Swedish patients with RA and OA compared with the general population. METHODS:: Cohort study of the population of Skåne region, Sweden (1.3 million), based on physicians’ diagnostic codes in a mandatory register covering all healthcare. We included all subjects aged ≥45 years who between 1998 and 2012 consulted any physician at least once. We identified those who received a diagnosis of RA, knee OA or hip OA. We followed all subjects until death, relocation outside Skåne region, or end of 2013, and analyzed data using Cox proportional hazard regression with attained age as time scale. RESULTS:: We identified 8067 patients with RA, 51939 with knee OA and 29442 with hip OA among 524136 in the population aged ≥45 years. The mortality rates adjusted for sex, socioeconomic status and comorbidities were elevated for RA, hazard ratio 1.86 (95% confidence interval 1.78,1.94) but not in knee or hip OA compared with the general population seeking healthcare, hazard ratio 0.87 (0.85,0.89) and 0.90 (0.87,0.92), respectively. Extensive sensitivity analyses supported the conclusion of no increased mortality in OA. CONCLUSIONS:: In Sweden, RA is associated with about doubled mortality rate, but we found no increased mortality in patients with knee and hip OA. Possible selection of those seeking physician care for knee or hip pain and/or OA management in healthcare are plausible explanations.
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| 2. |
- Jordan, Kelvin P., et al.
(author)
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International comparisons of the consultation prevalence of musculoskeletal conditions using population-based healthcare data from England and Sweden
- 2014
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 73:1, s. 212-218
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Journal article (peer-reviewed)abstract
- Objectives To assess the consultation prevalence of musculoskeletal (MSK) conditions as presented in different healthcare systems, and to determine the feasibility of comparing prevalence figures between nations. Methods The settings were an English regional database (Consultations in Primary Care Archive (CiPCA)) and the Swedish Skane County Health Care Register. Case definitions, data extraction and analysis procedures were harmonised. The number of people consulting per 10000 registered population in primary care, and in primary or secondary care, in the year 2010 (annual consultation prevalence) were determined for doctor-diagnosed osteoarthritis (OA), rheumatoid arthritis (RA), low back pain, and spondyloarthritis including psoriatic arthritis and ankylosing spondylitis (AS). Seven-year period consultation prevalences were also determined. Results Combining primary and secondary care, annual consultation prevalences of any MSK condition (2143 vs 1610/10000) and low back pain (587 vs 294/10000) were higher in England than in Sweden, but higher for RA, spondyloarthritis and psoriatic arthritis in Sweden. Annual primary care prevalence figures for OA (176 vs 196/10000), RA (25 vs 26/10000), spondyloarthritis (both 8/10000) and psoriatic arthritis (5 vs 3/10000) were similar between England and Sweden. AS was rarely recorded in Swedish primary care. These patterns were also observed for 7-year period consultation prevalences. Conclusions A rigorous methodological approach allowed feasible comparison of MSK consultation prevalence between England and Sweden. Differences in prevalence of inflammatory and unspecific pain conditions may be partially explained by known variations in healthcare systems and recording practice. Routine healthcare data offers potential for investigating variations in occurrence and outcome of MSK conditions between nations.
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| 3. |
- Peat, George, et al.
(author)
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Population-wide incidence estimates for soft tissue knee injuries presenting to healthcare in southern Sweden: data from the Skane Healthcare Register
- 2014
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In: Arthritis Research and Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 16:4
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Journal article (peer-reviewed)abstract
- Introduction: Soft tissue knee injury is a well-established and potent risk factor for development of knee osteoarthritis. However, there is a paucity of epidemiological data from the general population. Our aim was to estimate the annual person-level incidence for a wide spectrum of clinically diagnosed soft tissue knee injuries, and their distribution by age, sex, and season. Methods: In Sweden, in-and outpatient health care is registered using each individuals' unique personal identifier including International Classification of Diseases (ICD) 10 diagnostic code(s) as determined by physicians' clinical examination. For the calendar years 2004-2012, we studied the population in southern Sweden, Skane region (approx. 1.3 million). We identified residents who had at least one visit to a physician with clinically diagnosed knee ligament, meniscal, or other soft-tissue injury (S80.0, S83 and all subdiagnoses). We then calculated the mean annual incidence over the 9-year period. As a secondary objective, we investigated potential seasonal variation. Results: The annual incidence for males and females was 766 (95% CI: 742, 789) and 676 (649, 702) per 100,000 persons/year respectively. For males and females, the peak rate occurred in 15 to 19 year-olds (1698 per 100,000 men and 1464 per 100,000 women, respectively). In women, rates were lowest in the 25 to 34 year-old age range before rising again between the ages of 35 and 49 years. We found substantial seasonal variation, greatest in men, with peaks in March-May and August-October. Conclusions: The incidence of clinically diagnosed soft-tissue knee injury peaks in adolescence and emerging adulthood. However, a range of knee injuries continue to occur across the adult lifespan including at ages when osteoarthritis is typically diagnosed and managed. The potential cumulative effect on osteoarthritis progression of these injuries may warrant further investigation.
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| 4. |
- Yu, Dahai, et al.
(author)
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Population trends in the incidence and initial management of osteoarthritis : age-period-cohort analysis of the Clinical Practice Research Datalink, 1992-2013
- 2017
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In: Rheumatology. - : Oxford University Press (OUP). - 1462-0332 .- 1462-0324. ; 56:11, s. 1902-1917
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Journal article (peer-reviewed)abstract
- Objective: To determine recent trends in the rate and management of new cases of OA presenting to primary healthcare using UK nationally representative data.Methods: Using the Clinical Practice Research Datalink we identified new cases of diagnosed OA and clinical OA (including OA-relevant peripheral joint pain in those aged over 45 years) using established code lists. For both definitions we estimated annual incidence density using exact person-time, and undertook descriptive analysis and age-period-cohort modelling. Demographic characteristics and management were described for incident cases in each calendar year. Sensitivity analyses explored the robustness of the findings to key assumptions.Results: Between 1992 and 2013 the annual age-sex standardized incidence rate for clinical OA increased from 29.2 to 40.5/1000 person-years. After controlling for period effects, the consultation incidence of clinical OA was higher for successive cohorts born after the mid-1950s, particularly women. In contrast, with the exception of hand OA, we observed no increase in the incidence of diagnosed OA: 8.6/1000 person-years in 2004 down to 6.3 in 2013. In 2013, 16.4% of clinical OA cases had an X-ray referral. While NSAID prescriptions fell from 2004, the proportion prescribed opioid analgesia rose markedly (0.1% of diagnosed OA in 1992 to 1.9% in 2013).Conclusion: Rising rates of clinical OA, continued use of plain radiography and a shift towards opioid analgesic prescription are concerning. Our findings support the search for policies to tackle this common problem that promote joint pain prevention while avoiding excessive and inappropriate health care.
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