Osteoarthritis year in review 2023: Epidemiology & therapy.

OBJECTIVE: To highlight some important findings from osteoarthritis (OA) epidemiology and therapy research undertaken over the past year. METHODS: Search of MEDLINE and EMBASE databases between April 1, 2022 to March 3, 2023 using "exp *Osteoarthritis/" as the preliminary search term. The search was limited to articles published in English and including human subjects. Final inclusions were based on perceived importance and results that may inform improved identification of risk factors or OA treatments, as well as OA subgroups of potential relevance to risk factors or treatment approaches. RESULTS: 3182 studies were screened, leaving 208 eligible for inclusion. This narrative review of thirty-three selected studies was arranged into: a) OA predictors - population-based studies, b) Specific predictors of OA and OA outcome; c) Intra-articular injections, and d) OA phenotypes. There was some suggestion of sex differences in predictors of incidence or outcomes. Body mass index changes appear largely to affect knee OA outcomes. Evidence points to a lack of benefit of viscosupplementation in knee OA; findings were variable for other injectables. Studies of OA phenotypes reveal potentially relevant clinical and pathophysiological differences. CONCLUSIONS: Identifying risk factors for the incidence/progression of OA represents an ongoing and important area of OA research. Sex may play a role in this understanding and bears consideration and further study. For knee injectables other than viscosupplementation, additional high-quality trials appear warranted. Continued investigation and application of phenotyping across the OA disease, illness and care spectrum may be key to developing disease-modifying agents and their appropriate selection for individuals.

Differences in Practice Patterns and Payments for Female and Male Dermatologists: A Canadian Population-Based Study Over 3 Decades.

BACKGROUND: Canada's fee-for-service physician reimbursement system, where a set rate is provided for each service, suggests that a physician sex pay gap should not exist. However, recent evidence has questioned this presumption. OBJECTIVES: To characterize trends in demographics and billing, overall and by sex, for dermatologists compared to other medical and surgical specialty groups in Ontario, Canada. METHODS: Using population-based data, analysis of physician billing and clinical activity from Ontario, Canada, over 27 years (1992-2018) was performed. Multilevel regression models were used to examine unadjusted and adjusted differences in payments between females and males over time, while controlling for age, distinct patients seen, patient visits, and full-time equivalent. RESULTS: A total of 22 389 physicians were included in the analyses, including 381 dermatologists. The proportion of female dermatologists increased from 32% in 1992 to 46% in 2018. Dermatologists' median Ontario Health Insurance Plan (OHIP) payments were $415 340 (IQR: 285 630-566 580) in 1992 compared to $296 750 (IQR: 164 480-493 180) in 2018. Male dermatologists' OHIP payments were 20% more than their female counterparts across the entire study period. After adjusting for practice volumes, there was no significant pay gap amongst female and male dermatologists (P = .42); however, the sex pay gap remained significant for the other specialty groups (P < .001). From 1992 to 2018, dermatologists on average saw 19% fewer distinct patients per year and 15% fewer visits per patient. CONCLUSIONS: The overall sex pay gap within medical dermatology can be attributed to differences in practice patterns, whereas the sex pay gap remained significant in the other specialty groups.

Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis.

BACKGROUND: Using longitudinal panel data, the aim of this study was to examine the contribution of age, period, and cohort effects on changes in physical activity over time in a population-based sample of Canadians. We focused on three domains of physical activities: leisure time, commuting (i.e. walking and cycling), and daily activities (i.e. sedentary behavior). We also examined whether changes in sedentary behavior related to changes in participation in leisure time and commuting activities. METHODS: We used data from the Longitudinal National Population Health Survey (1994-2011): 10050 participants born between 1935 and 1984 grouped in five 10-years birth cohorts. We examined three outcomes: moderate-to-vigorous leisure time physical activity, active commuting, and sedentary behavior. We also included education, income, and body mass index as covariates. We used hierarchical age-period-cohort analysis to examine the contribution of age, period, and cohort effects to changes over time for each outcome. RESULTS: We found that recent cohorts were more likely to report sedentary behavior and greater participation in leisure time physical activities and active commuting. We also found a significant trend of increasing participation in active leisure time physical activity and active commuting among Canadians from 1994/95 to 2010/11 and, at the same time, an increase in sedentary behavior. The greater participation in leisure time physical activities and active commuting in each succeeding recent cohort was partially related to the secular trend of increasing participation in physical activities over time in the population. Furthermore, those with sedentary behavior were less likely to report participation in physical activities. Overall, obese individuals were less likely to be physically active and more likely to be sedentary, while the effect of socio-economic status varied by outcome. CONCLUSIONS: The greater participation in physical activities (leisure time and commuting) in recent cohorts is encouraging and was substantially explained by period effects, which reflect broad social and environmental factors affecting the whole population. The large cohort effect of increasing sedentary behavior and the inverse relationship between sedentary behavior and physical activity is concerning, and identifies a target group for future interventions.

Commonalities and differences in the implementation of models of care for arthritis: key informant interviews from Canada.

BACKGROUND: Timely access to effective treatments for arthritis is a priority at national, provincial and regional levels in Canada due to population aging coupled with limited health human resources. Models of care for arthritis are being implemented across the country but mainly in local contexts, not from an evidence-informed policy or framework. The purpose of this study is to examine existing models of care for arthritis in Canada at the local level in order to identify commonalities and differences in their implementation that could point to important considerations for health policy and service delivery. METHODS: Semi-structured key informant interviews were conducted with 70 program managers and/or care providers in three Canadian provinces identified through purposive and snowball sampling followed by more detailed examination of 6 models of care (two per province). Interviews were transcribed verbatim and analyzed thematically using a qualitative descriptive approach. RESULTS: Two broad models of care were identified for Total Joint Replacement and Inflammatory Arthritis. Commonalities included lack of complete and appropriate referrals from primary care physicians and lack of health human resources to meet local demands. Strategies included standardized referrals and centralized intake and triage using non-specialist health care professionals. Differences included the nature of the care and follow-up, the role of the specialist, and location of service delivery. CONCLUSIONS: Current models of care are mainly focused on Total Joint Replacement and Inflammatory Arthritis. Given the increasing prevalence of arthritis and that published data report only a small proportion of current service delivery is specialist care; provision of timely, appropriate care requires development, implementation and evaluation of models of care across the continuum of care.

Benefits gained, benefits lost: comparing baby boomers to other generations in a longitudinal cohort study of self-rated health.

UNLABELLED: POLICY POINTS: Despite beliefs that baby boomers are healthier than previous generations, we found no evidence that the health of baby boomers is substantially different from that of the previous or succeeding cohorts. The effects of increased education, higher income, and lower smoking rates on improving self-rated health were nearly counterbalanced by the adverse effect of increasing body mass index (BMI). Assumptions that baby boomers will require less health care as they age because of better education, more prosperity, and less propensity to smoke may not be realized because of increases in obesity. CONTEXT: Baby boomers are commonly believed to be healthier than the previous generation. Using self-rated health (SRH) as an indicator of health status, this study examines the effects of age, period, and birth cohort on the trajectory of health across 4 generations: World War II (born between 1935 and 1944), older baby boomers (born between 1945 and 1954), younger baby boomers (born between 1955 and 1964), and Generation X (born between 1965 and 1974). METHODS: We analyzed Canada's longitudinal National Population Health Survey 1994-2010 (n = 8,570 at baseline), using multilevel growth models to estimate the age trajectory of SRH by cohort, accounting for period and incorporating the influence of changes in education, household income, smoking status, and body mass index (BMI) on SRH over time. FINDINGS: SRH worsened with increasing age in all cohorts. Cohort differences in SRH were modest (p = 0.034), but there was a significant period effect (p = 0.002). We found marked cohort effects for increasing education, income, and BMI, and decreasing smoking from the youngest to the oldest cohorts, which were much reduced (education and smoking) or removed (income and BMI) once period was taken into account. At the population level, multivariable analysis showed the benefits of increasing education and income and declines in smoking on the trajectory of improving SRH were almost counterbalanced by the effects of increasing BMI (obesity). CONCLUSIONS: We found no evidence to support the expectation that baby boomers will age more or less healthily than previous cohorts did. We also found that increasing BMI has likely undermined improvements in health that might have otherwise occurred, with possible implications for the need for health care. Period effects had a more profound effect than birth cohort effects. This suggests that interventions to improve health, such as reducing obesity, can be targeted to the entire, or a major portion of the, population and need not single out particular birth cohorts.

Arthritis has an impact on the daily lives of Canadians young and old: results from a population-based survey.

BACKGROUND: There is a perception that the impacts of arthritis are greatest among older adults. However, the effect of age on health-related outcomes in individuals with arthritis has not been explicitly studied. This study examined whether the physical and mental health impacts of arthritis are greater in older (75+ years) versus younger (20-44, 45-64 and 65-74 years) Canadian adults. METHODS: Data were from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. The responses were weighted to be representative of Canadians (≥20 years) with arthritis. Associations between age and the prevalence of severe/frequent joint pain, severe/frequent fatigue, sleep limitations, instrumental activities of daily living (IADLs) limitations, high levels of stress, suboptimal general and suboptimal mental health, were examined descriptively prior to conducting multivariate log-binomial regression analyses. RESULTS: A total of 4565 respondents completed the survey (78% response rate). Individuals with arthritis were mostly female (63%), of working age (57%) and overweight or obese (67%). Upon adjusting for covariates, younger (20-44 years) and/or middle aged (45-64 years) adults were more likely than those older (75+ years) to report severe/frequent joint pain, sleep limitations, high levels of stress and suboptimal mental health. After adjusting for covariates, age was not associated with IADL limitations, severe/frequent fatigue or suboptimal general health. CONCLUSIONS: Contrary to the belief that older adults with arthritis experience more severe physical and mental health outcomes, we found that older adults were less likely to report worse outcomes than younger adults. In light of these findings, public health messaging should stress that arthritis does not just affect the elderly and emphasize the importance of timely diagnosis and management at all ages in order to prevent or, minimize arthritis-related impairment.

High health care use prior to elective surgery for osteoarthritis is associated with poor postoperative outcomes: A Canadian population-based cohort study.

BACKGROUND: The characterization and influence of preoperative health care use on quality-of-care indicators (e.g., readmissions) has received limited attention in populations with musculoskeletal disorders. The purpose of this study was to characterize preoperative health care use and examine its effect on quality-of-care indicators among patients undergoing elective surgery for osteoarthritis. METHODS: Data on health care use for 124,750 patients with elective surgery for osteoarthritis in Ontario, Canada, from April 1, 2015 to March 31, 2018 were linked across health administrative databases. Using total health care use one-year previous to surgery, patients were grouped from low to very high users. We used Poisson regression models to estimate rate ratios, while examining the relationship between preoperative health care use and quality-of-care indicators (e.g., extended length of stay, complications, and 90-day hospital readmissions). We controlled for covariates (age, sex, neighborhood income, rural/urban residence, comorbidities, and surgical anatomical site). RESULTS: We found a statistically significant trend of increasing worse outcomes by health care use gradients that persisted after controlling for patient demographics and comorbidities. Findings were consistent across surgical anatomical sites. Moreover, very high users have relatively large numbers of visits to non-musculoskeletal specialists. CONCLUSIONS: Our findings highlight that information on patients' preoperative health care use, together with other risk factors (such as comorbidities), could help decision-making when benchmarking or reimbursing hospitals caring for complex patients undergoing surgery for osteoarthritis.

Examining the longitudinal associations between activity limitations, instrumental supports and social participation in osteoarthritis: A CLSA population-based study.

OBJECTIVE: In osteoarthritis (OA) research, disability is largely studied within the context of activities of daily living. Broader consequences for social participation are often overlooked. In prior work, instrumental supports received and their perceived availability were shown to play a role in the maintenance of social participation. Two indicators of social participation were identified, diversity and intensity. The current study extends the findings from this prior cross-sectional work by examining these relationships longitudinally. METHODS: Data are from the baseline and 3-year follow-up questionnaires of the Canadian Longitudinal Study on Aging, a population-based study of people ages 45-85 years at baseline. The sample was restricted to those who at baseline reported a doctor diagnosis of OA (n = 4104). Using structural equation modeling, latent variables were derived at each time point for activity limitations, instrumental supports perceived and received, and social participation diversity and intensity. Longitudinal factorial invariance was assessed. Model covariates included age, sex, education, income, marital status, smoking status, obesity, and number of chronic conditions. RESULTS: For all latent variables, strong factorial longitudinal invariance was found. Activity limitations increased over time. Greater baseline social participation intensity was associated with increases in later intensity and diversity. Increasing activity limitations were associated with decreases in social participation and with increasing receipt of instrumental supports; they were not associated with changes in perceived availability of supports. However, increasing perceived availability was positively associated with social participation intensity. CONCLUSIONS: With a goal of increasing social participation, findings suggest a focus on interventions to reduce activity limitations in OA is necessary. Findings additionally highlight an important role for perceived availability of instrumental supports in maintaining or improving social participation in OA, in addition to current social participation, particularly intensity, for future social participation status.

The impact of diabetes status on pain and physical function following total joint arthroplasty for hip and knee osteoarthritis: variation by sex and body mass index.

Few studies have examined diabetes impact on total joint arthroplasty (TJA) outcomes, with variable findings. We investigated the association between diabetes and post-TJA physical function and pain, examining whether diabetes impact differs by sex and BMI. Patient sample completed questionnaires within 3 months prior to hip or knee TJA for osteoarthritis (OA) and 1-year post-surgery. Surgical 'non-response' was defined as < 30% improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function at 1-year. Two adjusted logistic regression models were estimated: (1) excluding, (2) including an interaction between diabetes, sex and BMI. The sample (626 hip, 754 knee) was 54.9% female, had mean BMI of 30.1, 13.0% reported diabetes. In adjusted models excluding an interaction, diabetes was not associated with non-response. However, a significant 3-way interaction (physical function: p = 0.003; pain: p = 0.006) between diabetes, sex, and BMI was found and was associated with non-response: non-response probability increased with increasing BMI in men with diabetes, but decreased with increasing BMI in women in diabetes. Findings suggest uncertainty in diabetes impact may be due to differential impacts by sex and BMI. A simple consideration of diabetes as present vs. absent may not be sufficient, with implications for the large TJA population.

The impact of diabetes on physical and mental health status and patient satisfaction after total hip and knee arthroplasty.

OBJECTIVE: To assess the impact of diabetes on physical and mental health status, as well as patient satisfaction, one-year following knee and hip total joint arthroplasty (TJA) for osteoarthritis (OA). METHODS: Participants were 626 hip and 754 knee TJA patients. Pre-surgery data were collected on socio-demographics and health status. The 12-item Short Form Health Survey (SF-12) was collected pre- and one year post-surgery, and physical (PCS) and mental component (MCS) summary scores computed. One-year patient satisfaction was also recorded. Four regression models tested the effect of diabetes on: 1) PCS change score; 2) MCS change score; 3) achieving minimal clinically important improvement (MCII) on PCS; and 4) patient satisfaction ('Somewhat or Very Satisfied' vs. 'Somewhat or Very Dissatisfied'). An interaction between surgical joint and diabetes was tested in each model. RESULTS: Self-reported diabetes prevalence was 13.0% (95% CI: 11.2%-14.7%) and was more common in knee 16.1% (95% CI: 13.4%-18.7%) than hip 9.3% (95% CI: 7.0%-11.5%) patients. In adjusted analyses, change scores were 2.3 units less on the PCS for those with diabetes compared to those without (p = 0.005). Patients with diabetes were about half as likely to achieve MCII as patients without diabetes (p = 0.004). Diabetes was not significantly associated with satisfaction or changes in MCS scores. Diabetes effects did not differ by surgical joint. CONCLUSIONS: Findings support that diabetes has a negative impact on improvements in physical health after TJA. Considering the growing prevalence of OA and diabetes in the population, our findings support the importance of perioperative screening and management of diabetes in patients undergoing TJA.

Backlog in ophthalmic surgeries associated with the COVID-19 pandemic in Ontario 2020.

OBJECTIVE: To assess the volume of deferred ophthalmic surgeries in Ontario associated with the COVID-19 pandemic from March to December 2020 and suggest strategies and time required to clear the backlog. DESIGN: Cross-sectional study. PARTICIPANTS: Ontarians eligible for the Ontario Health Insurance Plan in 2017-2020. METHODS: Backlog and clearance time for ophthalmic surgeries associated with the COVID-19 pandemic were estimated from time-series forecasting models and queuing theory. RESULTS: From March 16 to December 31, 2020, the estimated ophthalmic surgical backlog needing operating rooms was 92,150 surgeries (95% prediction interval, 71,288-112,841). Roughly 90% of the delayed surgeries were cataract surgeries, and a concerning 4% were retinal detachment surgeries. Nearly half the provincial backlog (48%; 44,542 of 92,150) was in patients from the western health region. In addition, an estimated 23,755 (95% prediction interval, 14,656-32,497) anti-vascular endothelial growth factor injections were missed. Estimated provincial clearance time was 248 weeks (95% CI, 235-260) and 128 weeks (95% CI, 121-134) if 10% and 20% of operating room surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. CONCLUSIONS: Ontario data demonstrate that the magnitude of the ophthalmic surgical backlog in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues, the accrued backlog size is likely to increase. Planning and actions are needed urgently to better manage the collateral impacts of the pandemic on the ophthalmic surgical backlog.

Time trends and patterns in opioid prescription use following orthopaedic surgery in Ontario, Canada, from 2004/2005 to 2017/2018: a population-based study.

OBJECTIVES: Increased use of opioids and their associated harms have raised concerns around prescription opioid use for pain management following surgery. We examined trends and patterns of opioid prescribing following elective orthopaedic surgery. DESIGN: Population-based study. SETTING: Ontario, Canada. PARTICIPANTS: Ontario residents aged 66+ years who had elective orthopaedic surgery from April 2004 to March 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Postoperative opioid use (short term: within 90 days of surgery, prolonged: within 180 days and chronic: within 1 year), specific opioids prescribed, average duration (days) and amount (morphine milligram equivalents) of the initial prescription by year of surgery. RESULTS: We included 464 460 elective orthopaedic surgeries in 2004/2005-2017/2018: 80% of patients used opioids within 1 year of surgery-25.1% were chronic users. There was an 8% increase in opioid use within 1 year of surgery, from 75.1% in 2004/2005 to 80.9% in 2017/2018: a 29% increase in short-term use and a decline in prolonged (9%) and chronic (22%) use. After 2014/2015, prescribed opioid amounts initially declined sharply, while the duration of the initial prescription increased substantially. Across categories of use, there was a steady decline in coprescription of benzodiazepines and opioids. CONCLUSIONS: Most patients filled opioid prescriptions after surgery, and many continued filling prescriptions after 3 months. During a period of general increase in awareness of opioid harms and dissemination of guidelines/policies aimed at opioid prescribing for chronic pain, we found changes in prescribing practices following elective orthopaedic surgery. Findings illustrate the potential impact of guidelines/policies on shaping prescription patterns in the surgical population, even in the absence of specific guidelines for surgical prescribing.

Cardiovascular Risk Profile and Osteoarthritis-Considering Sex and Multisite Joint Involvement: A Canadian Longitudinal Study on Aging.

OBJECTIVE: The objective of this study was to investigate a profile of cardiovascular disease (CVD) risk factors by sex among individuals with and without osteoarthritis (OA) and to consider single-site and multisite joint OA. METHODS: Data were sourced from Cycle 1, Comprehensive Cohort, Canadian Longitudinal Study on Aging, a national sample of individuals ages 45 to 85 years. Systemic inflammatory/metabolic CVD risk factors collected were high-sensitivity C-reactive protein (hsCRP) level, high-density lipoprotein, triglycerides, total cholesterol, body mass index (BMI), systolic blood pressure, and hemoglobin A1c. Smoking history was also collected. Respondents indicated doctor-diagnosed OA in the knees, hips, and/or hands and were characterized as yes/no OA and single site/multisite OA. Individuals with OA were age- and sex-matched to non-OA controls. Covariates were age, sex, education, income, physical activity, timed up and go test findings, and comorbidities. A latent CVD risk variable was derived in women and men; standardized scores were categorized as follows: lowest, mid-low, mid-high, and highest risk. Associations with OA were quantified using ordinal logistic regressions. RESULTS: A total of 6,098 respondents (3,049 with OA) had a median age of 63 years, and 55.8% were women. One-third of OA respondents were in the highest risk category versus one-fifth of non-OA respondents. Apart from BMI (the largest contributor in both sexes), hsCRP level (an inflammation marker) was predominant in women, and metabolic factors and smoking were predominant in men. Overall, OA was associated with worse CVD risk quartiles compared with non-OA. OA was increasingly associated with worse CVD risk quartiles with increasing risk thresholds among women with multisite OA, but not men. CONCLUSION: Findings suggest unique CVD risks by sex/multisite subgroups and point to a potentially important role for inflammation in OA over and above traditional CVD risk factors.

Determining minimal clinically important difference estimates following surgery for degenerative conditions of the lumbar spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) registry.

BACKGROUND CONTEXT: There is significant variability in minimal clinically important difference (MCID) criteria for lumbar spine surgery that suggests population and primary pathology specific thresholds may be required to help determine surgical success when using patient reported outcome measures (PROMs). PURPOSE: The purpose of this study was to estimate MCID thresholds for 3 commonly used PROMs after surgical intervention for each of 4 common lumbar spine pathologies. STUDY DESIGN/SETTING: Observational longitudinal study of patients from the Canadian Spine Outcomes and Research Network (CSORN) national registry. PATIENT SAMPLE: Patients undergoing surgery from 2015 to 2018 for lumbar spinal stenosis (LSS; n = 856), degenerative spondylolisthesis (DS; n = 591), disc herniation (DH; n = 520) or degenerative disc disease (DDD n = 185) were included. OUTCOME MEASURES: PROMs were collected presurgery and 1-year postsurgery: the Oswestry Disability Index (ODI), and back and leg Numeric Pain Rating Scales (NPRS). At 1-year, patients reported whether they were 'Much better'/'Better'/'Same'/'Worse'/'Much worse' compared to before their surgery. Responses to this item were used as the anchor in analyses to determine surgical MCIDs for benefit ('Much better'/'Better') and substantial benefit ('Much better'). METHODS: MCIDs for absolute and percentage change for each of the 3 PROMs were estimated using a receiving operating curve (ROC) approach, with maximization of Youden's index as primary criterion. Area under the curve (AUC) estimates, sensitivity, specificity and correct classification rates were determined. All analyses were conducted separately by pathology group. RESULTS: MCIDs for ODI change ranged from -10.0 (DDD) to -16.9 (DH) for benefit, and -13.8 (LSS) to -22.0 (DS,DH) for substantial benefit. MCID for back and leg NPRS change were -2 to -3 for each group for benefit and -4.0 for substantial benefit for all groups on back NPRS. MCID estimates for percentage change varied by PROM and pathology group, ranging from -11.1% (ODI for DDD) to -50.0% (leg NPRS for DH) for benefit and from -40.0% (ODI for DDD) to -66.6% (leg NPRS for DH) for substantial benefit. Correct classification rates for all MCID thresholds ranged from 71% to 89% and were relatively lower for absolute vs percent change for those with high or low presurgical scores. CONCLUSIONS: Our findings suggest that the use of generic MCID thresholds across pathologies in lumbar spine surgery is not recommended. For patients with relatively low or high presurgery PROM scores, MCIDs based on percentage change, rather than absolute change, appear generally preferable. These findings have applicability in clinical and research settings, and are important for future surgical prognostic work.

Magnitude of impact and healthcare use for musculoskeletal disorders in the paediatric: a population-based study.

BACKGROUND: Although musculoskeletal disorders (MSD) are among the most prevalent chronic conditions, minimal attention has been paid to the paediatric population. The aim of this study is to describe the annual prevalence of healthcare contacts for MSD by children and youth age 0-19 years, including type of MSD, care delivery setting and the specialty of the physician consulted. METHODS: Analysis of data on all children with healthcare contacts for MSD in Ontario, Canada using data from universal health insurance databases on ambulatory physician and emergency department (ED) visits, same-day outpatient surgery, and in-patient admissions for the fiscal year 2006/07. The proportion of children and youth seeing different physician specialties was calculated for each physician and condition grouping. Census data for the 2006 Ontario population was used to calculate person visit rates. RESULTS: 122.1 per 1,000 children and youth made visits for MSD. The majority visited for injury and related conditions (63.2 per 1,000), followed by unspecified MSD complaints (33.0 per 1,000), arthritis and related conditions (27.7 per 1,000), bone and spinal conditions (14.2 per 1,000), and congenital anomalies (3 per 1,000). Injury was the most common reason for ED visits and in-patient admissions, and arthritis and related conditions for day-surgery. The majority of children presented to primary care physicians (74.4%), surgeons (22.3%), and paediatricians (10.1%). Paediatricians were more likely to see younger children and those with congenital anomalies or arthritis and related conditions. CONCLUSION: One in eight children and youth make physician visits for MSD in a year, suggesting that the prevalence of MSD in children may have been previously underestimated. Although most children may have self-limiting conditions, it is unknown to what extent these may deter involvement in physical activity, or be indicators of serious and potentially life-threatening conditions. Given deficiencies in medical education, particularly of primary care physicians and paediatricians, it is important that training programs devote an appropriate amount of time to paediatric MSD.

Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study.

BACKGROUND: The proportion of women entering medicine has increased in recent years, and understanding the different practice patterns of female and male family physicians (FPs) will provide important information for health workforce planning. We sought to evaluate differences by sex in the supply, payments and clinical activity among FPs in Ontario. METHODS: We conducted a cohort study using claims data from the Ontario Health Insurance Plan. We included all Ontario FPs who submitted claims from 1992 to 2018. We analyzed data using regression analyses for our outcomes of yearly number of FPs, payments, patient visits and distinct patients. RESULTS: The number of practising FPs increased from 10 370 in 1992 to 14 329 in 2018, with an annual increase of 155 female FPs and 13 male FPs. In 2018, male FPs outnumbered female FPs by 1159. Among male FPs, 32.7% worked less than 1 full-time equivalent (FTE) position, 18.1% worked 1 FTE and 49.2% worked more than 1 FTE, with little change over the 27-year study period. Among female FPs, the percentage of those who worked less than 1 FTE position decreased over time (58.6% in 1998 to 48.3% in 2015), those who worked 1 FTE was stable (22.2%-24.3%) and those who worked more than 1 FTE increased (18.7% in 1998 to 28.0% in 2017). Yearly payments were higher for male FPs than female FPs by 40%-60% overall and by 10%-20% in FPs who worked more than 1 FTE. For FPs who worked 1 FTE or less than 1 FTE, both sexes had similar payment amounts (from 2005-2018). For FPs who worked 1 FTE, female FPs were less likely to receive payments from fee-for-service after 2004, and had 550 fewer visits and 121 fewer patients annually than male FPs. INTERPRETATION: In Ontario, there are differences by sex in FP supply, payments, percentages of FTE groups, number of patient visits and number of distinct patients. Health administrators should be mindful of these differences when considering FP workforce plans to ensure a stronger primary health care system, with adequate health care delivery for the population.

Trends in payments among male and female ophthalmologists in Ontario from 1992 to 2018.

OBJECTIVE: To examine sex differences in Ontario Health Insurance Plan (OHIP) payments from 1992 to 2018. DESIGN: Population-based observational study. PARTICIPANTS: Ophthalmologists submitting claims to OHIP from 1992 to 2018. METHODS: Physician billing data over 27 years (1992-2018) were analyzed for yearly number of ophthalmologists, OHIP payments, distinct patients, and patient visits. RESULTS: Yearly median OHIP payments to female ophthalmologists were less than to male ophthalmologists with a gap ratio of 0.55 in 1992 to 0.73 in 2018. Stratifying by full-time equivalent (FTE), there was little difference in median payments between males and females for 1 FTE. Median female-to-male payments ratio varied from 0.80 to 1.16 for <1 FTE and 1.14 to 0.84 for >1 FTE from 1992 to 2018. Among female ophthalmologists, 72.7% and 52.9% were <1 FTE and 11.4% and 19.2% were >1 FTE in 1992 and 2018, respectively. In comparison, for male ophthalmologists, 35.7% and 45.6% were <1 FTE and 43.4% and 45.6% were >1 FTE in 1992 and 2018, respectively. Overall, male ophthalmologists had more patients and patient visits than female ophthalmologists, but there was little difference between male and female ophthalmologists for 1 and >1 FTE. The results for <1 FTE varied by year. CONCLUSIONS: Overall, female ophthalmologists have lower OHIP payments compared with males, but there was little difference for those stratified to 1 FTE. This overall payments difference by sex is largely explained by the higher proportion of <1 FTE females, lower proportion of >1 FTE females, and higher payments for >1 FTE males.

I don't know what type of arthritis I have: A population-based comparison of people with arthritis who knew their specific type and those who didn't.

OBJECTIVE: To understand differences between people with arthritis who do not know their type (DK) compared to those reporting osteoarthritis (OA) or inflammatory and autoimmune types of arthritis (IAA), including the receipt of appropriate health care, information, and services. METHODS: Analysis of the Survey on Living with Chronic Disease in Canada-Arthritis Component. Respondents aged ≥20 years with health professional-diagnosed arthritis (n = 4,385) were characterized as reporting DK, OA or IAA. Variables: arthritis characteristics (duration, number and site of joints affected), arthritis impact (current pain and fatigue, difficulty in sleeping and daily activities, impact on life), health (self-rated general and mental health, life stress), arthritis management strategies (seeing health professionals, medication use, assistive devices, receipt of arthritis information, self-management activities). Multinomial logistic and log-Poisson regressions were used, as appropriate, to compare the DK to the OA and IAA groups. RESULTS: In this arthritis sample, 44.2% were in the DK group, 38.3% reported OA and 17.5% reported IAA. Those in the DK group were more likely to be younger, have low income, low education, and be of non-white cultural background compared to those with OA. There were no significant differences in arthritis impact, but the DK group was less likely to have received information on, or have used, arthritis management strategies. CONCLUSIONS: The sociodemographic characteristics of the DK group suggest they likely have lower health literacy. They were less likely to have accessed health care and other support services, indicating this is an important group for health education, both for individuals with arthritis and health care providers.

Use of virtual care in ophthalmology in Ontario, Canada in 2020 during the COVID-19 pandemic.

OBJECTIVE: To investigate the use and trends of virtual care in ophthalmology and examine associated factors in a universal health care system during the COVID-19 pandemic in 2020. DESIGN: Cross-sectional study. PARTICIPANTS: Ontarians eligible for the Ontario Health Insurance Plan. METHODS: We used physician billing data from 2017-2020 to describe the use of virtual versus in-person care. We used logistic regression to examine factors associated with virtual care use. RESULTS: The uptake of ophthalmic virtual visits increased immediately following the government's directive to ramp down clinic activities and institution of a new virtual fee code (17.6%), peaked 2 weeks later (55.8%), and decreased immediately after the directive was lifted (24.2%). In March-December 2020, virtual visits were higher in female (11.6%) versus male (10.3%) patients and in patients <20 years of age (16.4%) and 20-39 years of age (12.3%) versus those aged 40-64 years (10.8%) and 65+ years (10.6%). Patients residing in the poorest/poorer neighbourhoods (10.9%) had similar use as their counterparts (11.1%). Patients with an acute infectious disease (14.2%) or nonurgent diagnosis (16.2%) had the highest use. Those with retinal disease had the lowest use (4.2%). Female ophthalmologists (15.4%) provided virtual care more often than male ophthalmologists (9.9%). Ophthalmologists aged 60-69 years (13.1%) provided virtual care more often than any other age groups (<40 years: 11.3%; 40-49 years: 11.0%; 50-59 years: 10.0%; and 70+ years: 7.7%). Multiple logistic regression models revealed similar results. CONCLUSION: Virtual care in ophthalmology increased significantly during the initial phase of the pandemic and decreased thereafter. There were significant variations in virtual care use by patient and ophthalmologist characteristics.