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AIM: To describe sociodemographic disparities in temporal trends of incidence and age distributions of first registered osteoarthritis (OA) diagnosis in southern Sweden. METHODS: We identified all Skåne residents aged 35+ who had lived in the region at any point during the period 2006-2019 with no previous OA diagnosis (ICD-10 codes M15-M19) for 8 years prior to inclusion in the study (n = 849,061). We calculated person-years from inclusion until OA diagnosis, death, emigration, or 31 December 2019, whichever occurred first. Combining sex (female, male), education (low, medium, high) and nativity (Swedish, immigrant), we created a variable with 12 strata. Average annual percent changes in age-standardized incidence rates were estimated using joinpoint regression. Changes in the median age-at-diagnosis (year of diagnosis minus birth year), weighted to the mid-2005 Swedish population, were explored. RESULTS: Cumulative age-standardized incidence rates ranged from 116 (95% CI: 111, 121) per 10,000 person-years for immigrant males with low education to 205 (95% CI: 200, 210) for immigrant females with medium education. The estimated average annual percent changes (ranging from 3.4% to 6.1%) were generally similar, with slightly greater variations among immigrants than Swedes. The weighted median age-at-diagnosis was higher for Swedes and low educated people. Immigrant females with low education were the only stratum with a reduction (3 years) in the weighted median age-at-diagnosis over time. Sociodemographic patterns in knee OA incidence were different from patterns for hip OA. CONCLUSIONS: There were few sociodemographic disparities in temporal trends of OA incidence and age-at-diagnosis, suggesting persistent sociodemographic disparities in OA burden in southern Sweden.
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OBJECTIVE: To investigate the associations between rheumatic and musculoskeletal diseases (RMDs) and incident dementia using population register-based data. METHODS: This nested case-control study was conducted based on a cohort of residents in the Skåne region, Sweden, aged 50 years and older in 2009 without doctor-diagnosed dementia during 1998 to 2009 (n = 402,825). Individuals with a new main diagnosis of dementia during 2010 to 2019 were identified as incident patients with dementia (n = 22,131). Controls without diagnosed dementia were randomly matched 1:1 by sex, age, and Elixhauser comorbidity index using incidence density sampling. Separate conditional logistic regression analyses adjusted for confounders were fitted for the following RMDs, diagnosed at least 2 years before dementia diagnosis as exposure: gout, osteoarthritis, rheumatoid arthritis, spondyloarthropathies (SpA), and systemic connective tissue disorders. Subgroup analyses by dementia subtype, sex, age, comorbidity, and RMDs/dementia identification were conducted. RESULTS: Although gout (adjusted rate ratio 0.88; 95% confidence interval 0.79-0.97), osteoarthritis (0.92; 0.88-0.96), and systemic connective tissue disorders (0.91; 0.83-0.99) were associated with decreased risk of dementia, the associations for rheumatoid arthritis (1.05; 0.92-1.19) and SpA (1.17; 0.94-1.45) were inconclusive. The associations between RMDs and incident dementia were similar across sex, age, and comorbidity subgroups with a few exceptions (eg, an adjusted rate ratio of 0.99 [95% confidence interval 0.71-1.39] in males vs 1.31 [0.99-1.74] in female patients for SpA). CONCLUSION: Persons with diagnosed RMDs seem to have comparable or slightly lower risks of developing dementia compared with those without known RMD.
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OBJECTIVES: To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references. METHODS: Cohort study using prospectively collected healthcare data from the Skåne region, Sweden (~1.4 million residents). We extracted diagnoses for OA and 67 common chronic conditions. We included individuals aged 40+ years on 31 December 2007, with incident OA between 2008 and 2009. We selected references without OA, matched on birth year, sex, and year of death or moving outside the region. We employed group-based trajectory modelling to capture morbidity count trajectories from 1998 to 2019. Individuals without any comorbidity were included as a reference group but were not included in the model. RESULTS: We identified 9846 OA cases (mean age: 65.9 (SD 11.7), female: 58%) and 9846 matched references. Among both cases and references, 1296 individuals did not develop chronic conditions (no-chronic-condition class). We identified four classes. At the study outset, all classes exhibited a low average number of chronic conditions (≤1). Class 1 had the slowest progression towards multimorbidity, which increased progressively in each class. Class 1 had the lowest count of chronic conditions at the end of the follow-up (mean: 2.9 (SD 1.7)), while class 4 had the highest (9.6 (2.6)). The presence of OA was associated with a 1.29 (1.12, 1.48) adjusted relative risk of belonging to class 1 up to 2.45 (2.12, 2.83) for class 4. CONCLUSIONS: Our findings suggest that individuals with OA face an almost threefold higher risk of developing severe multimorbidity.
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Multimorbidity , Osteoarthritis , Humans , Female , Male , Osteoarthritis/epidemiology , Aged , Sweden/epidemiology , Middle Aged , Adult , Morbidity/trends , Incidence , Chronic Disease/epidemiology , Prospective Studies , ComorbidityABSTRACT
OBJECTIVE: To investigate changes in analgesic use before and after participation in a digital first-line treatment program (exercise, patient education) in persons with knee or hip osteoarthritis (OA) and to explore associations between these changes in medication use and participant-reported pain and function. DESIGN: Retrospective cohort study with pre-post measures. SETTING: Community setting. PARTICIPANTS: Individuals (N=4100; mean age ± SD, 64.5±9.3y; 73.3% women) participating in the digital program. INTERVENTIONS: A digital supervised education and exercise therapy. MAIN OUTCOME MEASURES: Self-reported analgesic use for knee/hip pain during the past month at baseline and 12-week follow-up, knee/hip numeric rating scale pain (0-10, a higher value indicating more pain), and Knee Injury and Osteoarthritis Outcome Score 12 or Hip Disability and Osteoarthritis Outcome Score 12 function subscale (0-100, higher values indicating better function). McNemar test, multivariable logistic regression, and linear random intercept model were used for statistical analyses. RESULTS: Among participants, 61.4% and 49.4% were analgesic users at baseline and 12-week follow-up, respectively, (absolute reduction 12.0%; 95% confidence interval, 10.5-13.5). Being female, having hip OA, lower education, higher body mass index, living outside large metropolitan cities, coexisting rheumatoid arthritis, and walking difficulties were associated with higher odds of analgesic use at baseline. At both time points, persons not using analgesics at the time reported better outcomes. All groups but "new users" experienced improvements in their pain and function following participation in digital program with the greatest improvements observed among "quitters." CONCLUSIONS: Engaging in a digital exercise and patient education program as a primary treatment for knee or hip OA was associated with a reduction in the use of analgesics. The greatest improvements were seen for those who stopped analgesic use. These results highlight the importance of providing effective first-line treatment to people with knee or hip OA.
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BACKGROUND: In patients with a degenerative tear of the medial meniscus, recent meta-analyses and systematic reviews have shown no treatment benefit of arthroscopic partial meniscectomy (APM) over conservative treatment or placebo surgery. Yet, advocates of APM still argue that APM is cost effective. Giving advocates of APM their due, we note that there is evidence from the treatment of other musculoskeletal complaints to suggest that a treatment may prove cost effective even in the absence of improvements in efficacy outcomes, as it may lead to other benefits, such as diminished productivity loss and reduced costs, and so the question of cost effectiveness needs to be answered for APM. QUESTIONS/PURPOSES: (1) Does APM result in lower postoperative costs compared with placebo surgery? (2) Is APM cost-effective compared with placebo surgery? METHODS: One hundred forty-six adults aged 35 to 65 years with knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis according to the American College of Rheumatology clinical criteria were randomized to APM (n = 70) or placebo surgery (n = 76). In the APM and placebo surgery groups, mean age was 52 ± 7 years and 52 ± 7 years, and 60% (42 of 70) and 62% (47 of 76) of participants were men, respectively. There were no between-group differences in baseline characteristics. In both groups, a standard diagnostic arthroscopy was first performed. Thereafter, in the APM group, the torn meniscus was trimmed to solid meniscus tissue, whereas in the placebo surgery group, APM was carefully mimicked but no resection of meniscal tissue was performed; as such, surgical costs were the same in both arms and were not included in the analyses. All patients received identical postoperative care including a graduated home-based exercise program. At the 2-year follow-up, two patients were lost to follow-up, both in the placebo surgery group. Cost effectiveness over the 2-year trial period was computed as incremental net monetary benefit (INMB) for improvements in quality-adjusted life years (QALY), using both the societal (primary) and healthcare system (secondary) perspectives. To be able to consider APM cost effective, the CEA analysis should yield a positive INMB value. Nonparametric bootstrapping was used to assess uncertainty. Several one-way sensitivity analyses were also performed. RESULTS: APM did not deliver lower postoperative costs, nor did it convincingly improve quality of life scores when compared with placebo surgery. From a societal perspective, APM was associated with 971 (95% CI -2013 to 4017) higher costs and 0.015 (95% CI -0.011 to 0.041) improved QALYs over 2-year follow-up compared with placebo surgery. Both differences were statistically inconclusive (a wide 95% CI that crossed the line of no difference). Using the conventional willingness to pay (WTP) threshold of 35,000 per QALY, APM resulted in a negative INMB of -460 (95% CI -3757 to 2698). In our analysis, APM would result in a positive INMB only when the WTP threshold rises to about 65,000 per QALY. The wide 95% CIs suggests uncertain cost effectiveness irrespective of chosen WTP threshold. CONCLUSION: The results of this study lend further support to clinical practice guidelines recommending against the use of APM in patients with a degenerative meniscus tear. Given the robustness of existing evidence demonstrating no benefit or cost effectiveness of APM over nonsurgical treatment or placebo surgery, future research is unlikely to alter this conclusion.Level of Evidence Level III, economic analysis.
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OBJECTIVES: To investigate how the co-occurrence of diabetes, hypertension and overweight/obesity is associated with pain following an exercise intervention for knee and hip osteoarthritis (OA). METHODS: Register-based cohort study. We included people from the Swedish Osteoarthritis Register who underwent education and exercise for knee or hip OA. Diabetes and hypertension were defined using medical records and dispensation of medication. Body Mass Index (BMI) was used to identify people with overweight (≥25 to <30), and obesity (≥30). We used linear mixed-effect models with patients nested into clinics to estimate the associations between the exposures and pain (Numeric Rating Scale 0-10), adjusting for age, sex, education, and physical activity. RESULTS: We analysed 80,893 patients with knee or hip OA. The accumulation of metabolic conditions was associated with worse pain at baseline and follow-ups. When obesity, hypertension and diabetes coexisted, patients treated for knee OA reported more pain at baseline (adjusted mean pain difference 0.9 [95 %CI: 0.8; 1.0]), 3 months (1.0 [0.9; 1.1]) and 12 months (1.3 [1.1; 1.4]) compared to those without any of the conditions. Similar results were observed for patients treated for hip OA when obesity, hypertension and diabetes coexisted (baseline (0.7 [0.5; 0.8], 3 (0.8[0.6; 1.0]) and 12 months (1.1[0.8; 1.3]). CONCLUSIONS: When diabetes, hypertension and obesity coexist with OA, patients not only experience heightened baseline pain compared to metabolically healthy individuals, but the disparity increases after an education and exercise intervention suggesting that a one-size-fits-all approach may be inadequate in addressing the complex interplay between metabolic health and OA.
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Objective: To examine changes in prevalence and socioeconomic inequalities in knee and hip OA outcomes, in more specific surgery and non-surgery specialist care visits, from 2001 to 2011 in Sweden and to what extent sociodemographic factors can explain the changes. Design: We included all individuals aged ≥35 years resident in Sweden from 2001 to 2011. Individual-level data was retrieved from the Swedish Interdisciplinary Panel. Highest educational attainment was used as socioeconomic measure and the concentration index was used to assess relative and absolute educational inequalities. We used decomposition method to examine changes in prevalence and relative educational inequalities. Results: A total of 4,794,693 and 5,359,186 people were included for the years 2001 and 2011, respectively. The crude prevalence of surgery and specialist visits for knee and hip OA was 36-83% higher in 2011 than in 2001. The increase in hip OA outcomes was largely explained by changes in the sociodemographic composition of the population, whereas for knee OA outcomes, changes in the strength of the associations with sociodemographic factors appeared more important. All outcomes were concentrated among people with lower education in all study years. The relative inequalities declined over the study period, while the absolute inequalities increased for knee OA outcomes and remained stable for hip OA. Conclusion: Our findings show an increasing burden of all studied OA outcomes. Moreover, our findings suggest persistent educational inequalities with more surgeries and specialist visits among lower-educated individuals. Future research should incorporate additional variables to better understand and address these inequalities.
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OBJECTIVES: This study measures public health policies' and healthcare system's influence, by assessing the contributions of avoidable deaths, on the gender gaps in life expectancy and disparity (GGLD and GGLD, respectively) in the United States (US) and Canada from 2001 to 2019. METHODS: To estimate the GGLE and GGLD, we retrieved age- and sex-specific causes of death from the World Health Organization's mortality database. By employing the continuous-change model, we decomposed the GGLE and GGLD by age and cause of death for each year and over time using females as the reference group. RESULTS: In Canada and the US, the GGLE (GGLD) narrowed (increased) by 0.9 (0.2) and 0.2 (0.3) years, respectively. Largest contributor to the GGLE was non-avoidable deaths in Canada and preventable deaths in the US. Preventable deaths had the largest contributions to the GGLD in both countries. Ischemic heart disease contributed to the narrowing GGLE/GGLD in both countries. Conversely, treatable causes of death increased the GGLE/GGLD in both countries. In Canada, "treatable & preventable" as well as preventable causes of death narrowed the GGLE while opposite was seen in the US. While lung cancer contributed to the narrowing GGLE/GGLD, drug-related death contributed to the widening GGLE/GGLD in both countries. Injury-related deaths contributed to the narrowing GGLE/GGLD in Canada but not in the US. The contributions of avoidable causes of death to the GGLE declined in the age groups 55-74 in Canada and 70-74 in the US, whereas the GGLE widened for ages 25-34 in the US. CONCLUSION: Canada experienced larger reduction in the GGLE compared to the US attributed mainly to preventable causes of death. To narrow the GGLE and GGLD, the US needs to address injury deaths. Urgent interventions are required for drug-related death in both countries, particularly among males aged 15-44 years.
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Life Expectancy , Mortality , Male , Female , Humans , United States/epidemiology , Cause of Death , Sex Factors , Causality , Canada/epidemiologyABSTRACT
OBJECTIVE: To estimate patient acceptable symptom state (PASS) and treatment failure (TF) threshold values for Work Productivity and Activity Impairment (WPAI) measure and EQ-5D-5L among people with hip or knee osteoarthritis (OA) 3 and 12 months following participation in a digital self-management intervention (Joint Academy®). METHODS: Among the participants, we computed work and activity impairments scores (both 0-100, with a higher value reflecting higher impairment) and the Swedish hypothetical- (range: - 0.314 to 1) and experience-based (range: 0.243-0.976) EQ-5D-5L index scores (a higher score indicates better health status) at 3- (n = 14,607) and 12-month (n = 2707) follow-ups. Threshold values for PASS and TF were calculated using anchor-based adjusted predictive modeling. We also explored the baseline dependency of threshold values according to pain severity at baseline. RESULTS: Around 42.0% and 48.3% of the participants rated their current state as acceptable, while 4.2% and 2.8% considered the treatment had failed at 3 and 12 months, respectively. The 3-month PASS/TF thresholds were 16/29 (work impairment), 26/50 (activity impairment), 0.92/0.77 (hypothetical EQ-5D-5L), and 0.87/0.77 (the experience-based EQ-5D-5L). The thresholds at 12 months were generally comparable to those estimated at 3 months. There were baseline dependencies in PASS/TF thresholds with participants with more severe baseline pain considering poorer (more severe) level of WPAI/EQ-5D-5L as satisfactory. CONCLUSION: PASS and TF threshold values for WPAI and EQ-5D-5L might be useful for meaningful interpretation of these measures among people with OA. The observed baseline dependency of estimated thresholds limits their generalizability and values should be applied with great caution in other settings/populations.
Subject(s)
Osteoarthritis, Knee , Quality of Life , Humans , Male , Female , Middle Aged , Aged , Osteoarthritis, Knee/psychology , Treatment Failure , Surveys and Questionnaires , Sweden , Osteoarthritis, Hip/psychology , Efficiency , Health Status , Activities of Daily LivingABSTRACT
Objective: To explore sex and age differences in Patient-Reported Outcomes Measures (PROMs) and adherence to digital osteoarthritis (OA) self-management intervention. Methods: A register-based study with data from an OA digital self-management intervention. PROMs and adherence were collected at baseline and/or 3 âmonth follow-up: 'pain intensity' in hip/knee (best/worst: 0-10), 'activity impairments' (best/worst: 0-10), 'overall health' perception (worst/best: 0-10), 'physical function' (30-s chair stand test), 'health-related quality of life' (EQ-5D-5L index score; worst/best: 0.243-0.976), the subscales and total scores of the Knee Injury/Hip Disability and Osteoarthritis Outcome Score (KOOS/HOOS-12; worst/best: 0-100), 'fear of movement' (yes/no), 'walking difficulties' (yes/no), 'programme adherence' (0-100 â% and ≥80 â% [yes/no]), 'patient acceptable symptom state' (PASS; yes/no), and 'treatment failure' (those who answered no to PASS question and thought the treatment failed [yes/no]). We used linear/logistic regression to calculate mean/risk differences in the PROMs and adherence levels among sex and age groups at 3-month follow-up. We employed entropy balancing to explore the contributions of baseline characteristics and different covariates to the sex/age differences. Results: We included 14,610 participants (mean (SD) age: 64.1 (9.1), 75.5 â% females). Females generally reported better outcomes than males. Participants aged ≥70 had greater activity impairments, lower KOOS/HOOS-pain/function scores, more walking difficulties, less fear of movement and higher adherence than those <70. However, these differences were small and not likely clinically relevant. Conclusion: No clinically relevant differences in PROMs and adherence were found among sex/age groups in this digital OA programme, suggesting that sex/age seemed not to impact the outcomes of this intervention.
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OBJECTIVE: To examine income-related inequality changes in the outcomes of an osteoarthritis (OA) first-line intervention. DESIGN: Retrospective cohort study. SETTING: Swedish health care system. PARTICIPANTS: We included 115,403 people (age: 66.2±9.7 years; females 67.8%; N=115,403) with knee (67.8%) or hip OA (32.4%) recorded in the "Swedish Osteoarthritis Registry" (SOAR). INTERVENTIONS: Exercise and education. MAIN OUTCOME MEASURES: Erreygers' concentration index (E) measured income-related inequalities in "Pain intensity," "Self-efficacy," "Use of NSAIDs," and "Desire for surgery" at baseline, 3-month, and 12-month follow-ups and their differences over time. E-values range from -1 to +1 if the health variables are more concentrated among people with lower or higher income. Zero represents perfect equality. We used entropy balancing to address demographic and outcome imbalances and bootstrap replications to estimate confidence intervals for E differences over time. RESULTS: Comparing baseline to 3 months, "pain" concentrated more among individuals with lower income initially (E=-0.027), intensifying at 3 months (difference with baseline: E=-0.011 [95% CI: -0.014; -0.008]). Similarly, the "Desire for surgery" concentrated more among individuals with lower income initially (E=-0.009), intensifying at 3 months (difference with baseline: E=-0.012 [-0.018; -0.005]). Conversely, "Self-efficacy" concentrated more among individuals with higher income initially (E=0.058), intensifying at 3 months (difference with baseline: E=0.008 [0.004; 0.012]). Lastly, the "Use of NSAIDs" concentrated more among individuals with higher income initially (E=0.068) but narrowed at 3 months (difference with baseline: E=-0.029 [-0.038; -0.021]). Comparing baseline with 12 months, "pain" concentrated more among individuals with lower income initially (E=-0.024), intensifying at 12 months (difference with baseline: E=-0.017 [-0.022; -0.012]). Similarly, the "Desire for surgery" concentrated more among individuals with lower income initially (E=-0.016), intensifying at 12 months (difference with baseline: E=-0.012 [-0.022; -0.002]). Conversely, "Self-efficacy" concentrated more among individuals with higher income initially (E=0.059), intensifying at 12 months (difference with baseline: E=0.016 [0.011; 0.021]). The variable 'Use of NSAIDs' was not recorded in the SOAR at 12-month follow-up. CONCLUSION: Our results highlight the increase of income-related inequalities in the SOAR over time.
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Osteoarthritis, Hip , Female , Humans , Middle Aged , Aged , Cohort Studies , Retrospective Studies , Osteoarthritis, Hip/surgery , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Educational Status , PainABSTRACT
To investigate the association between chronic inflammatory rheumatic diseases (CIRD) and drug use disorder (DUD). Individuals aged ≥ 30 years in 2009 that met the following conditions were included: residing in the Skåne region, Sweden, with at least one healthcare contact in person and no history of DUD (ICD-10 codes F11-F16, F18-F19) during 1998-2009 (N = 649,891). CIRD was defined as the presence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), or systemic lupus erythematosus. Treating CIRD as a time-varying exposure, we followed people from January 1, 2010 until a diagnosis of DUD, death, relocation outside the region, or December 31, 2019, whichever occurred first. We used flexible parametric survival models adjusted for attained age, sociodemographic characteristics, and coexisting conditions for data analysis. There were 64 (95% CI 62-66) and 104 (88-123) incident DUD per 100,000 person-years among those without and with CIRD, respectively. CIRD was associated with an increased risk of DUD in age-adjusted analysis (hazard ratio [HR] 1.77, 95% CI 1.49-2.09). Almost identical HR (1.71, 95% CI 1.45-2.03) was estimated after adjustment for sociodemographic characteristics, and it slightly attenuated when coexisting conditions were additionally accounted for (1.47, 95% CI 1.24-1.74). Fully adjusted HRs were 1.49 (1.21-1.85) for RA, 2.00 (1.38-2.90) for AS, and 1.58 (1.16-2.16) for PsA. More stringent definitions of CIRD didn't alter our findings. CIRD was associated with an increased risk of DUD independent of sociodemographic factors and coexisting conditions. Key Points ⢠A register-based cohort study including 649,891 individuals aged≥30 residing in the Skåne region, Sweden, was conducted. ⢠Chronic inflammatory rheumatic diseases were associated with higher risks of drug use disorder independent of sociodemographic factors and coexisting conditions.
Subject(s)
Arthritis, Psoriatic , Arthritis, Rheumatoid , Rheumatic Diseases , Rheumatic Fever , Spondylitis, Ankylosing , Substance-Related Disorders , Humans , Cohort Studies , Arthritis, Psoriatic/complications , Risk Factors , Sweden/epidemiology , Arthritis, Rheumatoid/epidemiology , Arthritis, Rheumatoid/complications , Spondylitis, Ankylosing/complications , Substance-Related Disorders/complications , Chronic Disease , Rheumatic Diseases/epidemiology , Rheumatic Diseases/complicationsABSTRACT
OBJECTIVE: Digital self-management programs are increasingly used in the management of osteoarthritis (OA). Little is known about heterogeneous patterns in response to these programs. We describe weekly pain trajectories of people with knee or hip OA over up to 52-week participation in a digital self-management program. METHODS: Observational cohort study among participants enrolled between January 2019 and September 2021 who participated at least 4 and up to 52 weeks in the program (n = 16â274). We measured pain using Numeric Rating Scale (NRS 0-10) and applied latent class growth analysis to identify classes with similar trajectories. Associations between baseline characteristics and trajectory classes were examined using multinomial logistic regression and dominance analysis. RESULTS: We identified 4 pain trajectory classes: "mild-largely improved" (30%), "low moderate-largely improved" (34%), "upper moderate-improved" (24%), and "severe-persistent" (12%). For classes with decreasing pain, the most pain reduction occurred during first 20 weeks and was stable thereafter. Male sex, older age, lower body mass index (BMI), better physical function, lower activity impairment, less anxiety/depression, higher education, knee OA, no walking difficulties, no wish for surgery and higher physical activity, all measured at enrolment, were associated with greater probabilities of membership in "mild-largely improved" class than other classes. Dominance analysis suggested that activity impairment followed by wish for surgery and walking difficulties were the most important predictors of trajectory class membership. CONCLUSIONS: Our results highlight the importance of reaching people with OA for first-line treatment prior to developing severe pain, poor health status and a wish for surgery.
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Osteoarthritis, Hip , Osteoarthritis, Knee , Humans , Male , Osteoarthritis, Hip/complications , Osteoarthritis, Hip/therapy , Pain , Knee Joint , Knee , Osteoarthritis, Knee/complications , Osteoarthritis, Knee/therapy , ExerciseABSTRACT
BACKGROUND: Public health policies and healthcare quality play a pivotal role on the health outcome level and disparities across sociodemographic groups. However, there is little evidence on their role on disparities in life expectancy (LE) and life disparity (LD) in low and middle income countries. The present study aimed to assess the contributions of avoidable mortality, as a measure of inter-sectoral public health policies and healthcare quality, into the sex gap in LE (SGLE) and LD (SGLD) in Iran. METHODS: Latest available data of death causes, according to the ICD codes, for Iran was obtained from the WHO mortality database for the period 2015-2016. An upper age limit of 75 years was applied to define avoidable causes of death. LD was measured as the average years of life lost at birth. The SGLE and SGLD (both females minus males) were decomposed by age and cause of death using a continuous-change model. RESULTS: Females, on average, outlived males for 3.8 years (80.0 vs. 76.2 years) with 1.9 lower life years lost (12.6 vs. 14.4 years). Avoidable causes accounted for 2.5 (67%) and 1.5 (79%) years of the SGLE and SGLD, respectively. Among avoidable causes, injury-related deaths followed by ischaemic heart disease had the greatest contributions to both SGLE and SGLD. Across age groups, the age groups 55-59 and 60-64 accounted for the greatest contributions of avoidable causes to SGLE (0.3 years each), while age groups 20-24 and 55-59 had the greatest contributions to SGLD (0.15 years each). Lower mortality rates for females than males in age groups 50-74 years accounted for about half of the SGLE, while age groups 20-29 and 50-64 years accounted for around half of SGLD. CONCLUSION: More than two third of the SGLE and SGLD in Iran were attributed to the avoidable mortality, particularly preventable causes. Our results suggest the need for public health policies targeting injuries in young males as well as lifestyle risk factors including smoking in middle aged males in Iran.
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Hand osteoarthritis (OA) is a common form of OA, for which education and exercise are considered the first-line treatment. The aim of the present study was to examine pain and perceived hand function in participants following 3 months of digitally delivered first-line treatment for hand OA. Three-hundred-and-seventy-nine of 846 participants with clinical signs and symptoms of hand OA completed the study. The digital hand OA treatment program consists of video instructed daily exercises and patient education through text lessons. Pain (NRS, 0 no pain, 10 worst) was the primary outcome, and stiffness (NRS) and the Functional Index for Hand OsteoArthritis (FIHOA, 0 best, 30 worst) were among secondary outcomes. The McNemar test and linear mixed effect regression model were used to assess the changes in outcomes from baseline to 3-month. After three months, the digitally delivered program was associated with a significant decrease in pain intensity (mean change -1.30 (95% CI -1.49, -1.12)) and hand stiffness (mean change -0.81 (95% CI -1.02, -0.60)) but no conclusive changes in the FIHOA scores (mean change 0.3 (95% CI -0.2, 0.7)). The results agree with reports on face-to-face delivered first-line treatment for hand OA suggesting that digital treatment is a viable treatment option in patients with hand OA.
Subject(s)
Osteoarthritis, Knee , Osteoarthritis , Humans , Osteoarthritis/diagnosis , Exercise Therapy/methods , Exercise , Pain , Osteoarthritis, Knee/therapyABSTRACT
Objective: Establish proportions of patients reporting important improvement, acceptable symptoms and treatment failure and define interpretation threshold values for pain, patient-reported function and quality-of-life after participating in digital first-line treatment including education and exercise for hip and knee osteoarthritis (OA). Methods: Observational study. Responses to the pain Numeric Rating Scale (NRS, 0-10 best to worst), Knee injury and Osteoarthritis Outcome Score 12 (KOOS-12) and Hip disability and Osteoarthritis Outcome Score 12 (HOOS-12, both 0-100 worst to best) were obtained for 4383 (2987) and 2041 (1264) participants with knee (hip) OA at 3 and 12 months post intervention. Threshold values for Minimal Important Change (MIC), Patient Acceptable Symptom State (PASS) and Treatment Failure (TF) were estimated using anchor-based predictive modeling. Results: 70-85% reported an important improvement in pain, function and quality of life after 3 and 12 months follow-up. 42% (3 months) and 51% (12 months) considered their current state as satisfactory, whereas 2-4% considered treatment failed. MIC values were -1 (NRS) and 0-4 (KOOS/HOOS-12) across follow-ups and joint affected. PASS threshold value for NRS was 3, and 53-73 for the KOOS/HOOS-12 subscales Corresponding values for TF were 5 (NRS) and 34-55 (KOOS/HOOS-12). Patients with more severe pain at baseline had higher MIC scores and accepted poorer outcomes at follow-ups. Conclusion: Threshold estimates aid in the interpretation of outcomes after first-line OA interventions assessed with NRS Pain and KOOS/HOOS-12. Baseline pain severity is important to consider when interpreting threshold values after first-line interventions in these patients.
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Purpose: (i) To report the prevalence of participants to a first-line intervention for OA in Sweden using over-the-counter (OTC) and/or prescribed NSAIDs; (ii) To estimate the accuracy of dispensed prescriptions of NSAIDs recorded in a Swedish health-care register to capture the use of NSAID considering clinician-report as reference standard. Methods: Register-based study. We used data from OA individuals who participated in the Swedish first-line intervention recorded in the Swedish Osteoarthritis Register (SOAR). SOAR includes clinician-reported use of NSAIDs in the three months preceding the intervention. We used the Prescribed Drug Register to retrieve data on NSAID prescriptions dispensed in the same period. We estimated the prevalence of OTC users (individuals with clinicians-reported use of NSAID but no prescription dispensed), prescription users (individuals with clinicians-reported use of NSAID and a prescription dispensed) and non-users (neither of the previous). We calculated sensitivity, specificity, positive predictive value, and negative predictive value of dispensed prescriptions of NSAIDs vs clinician-report. Results: We included 116,162 individuals (mean age [Standard Deviation]: 66 [9.6] years, 79% women, 77% knee OA). Overall, 24.7% (95% Confidence Intervals [CI] 24.5%; 25.0%) used OTC NSAIDs only, 18.2% (18.0%; 18.5%) used prescribed NSAIDs, 6.6% (6-4%; 6.7%) reported not using NSAIDs while having an NSAID prescription dispensed. Of the 49,913 individuals with clinician-reported use of NSAIDs, 21,190 had a prescription dispensed (sensitivity: 42.5% [95% CI 42.0%, 42.9%]; positive predictive value: 73.5% [73.0%, 74.0%]). Of the 66,249 individuals reporting not using NSAIDs, 58,617 did not have a prescription dispensed (specificity: 88.5% [88.2%, 88.7%]; negative predictive value: 67.1% [66.8%, 67.4%]). Conclusion: Overall, 24.7% of participants in a first-line intervention for OA used OTC NSAIDs only while 18.2% used prescribed NSAIDs. Dispensed prescriptions of NSAIDs have high specificity but low sensitivity and can correctly identify about 70% of both the non-users and users in this population.
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AIM: To study the association between within-person changes in patient-reported outcomes (PROMs) and wish for joint surgery during participation in a digital first-line intervention comprising exercise and education for knee/hip osteoarthritis (OA). METHODS: Retrospective observational registry study. Participants enrolled between June 1, 2018 and October 30, 2021, with follow-up data at three months (n = 13,961). We used asymmetric fixed effect (conditional) logistic regressions to study the association between change in wish to undergo surgery at last available time point (3, 6, 9, or 12 months) and improvement or worsening of PROMs pain (0-10), quality of life (QoL) (EQ5D-5L, 0.243-0.976), overall health (0-10), activity impairment (0-10), walking difficulties (yes/no), fear of movement (yes/no), and Knee/Hip injury and Osteoarthritis Outcome Score 12 Items (KOOS-12/HOOS-12, 0-100) function and QoL subscales. RESULTS: The proportion of participants wishing to undergo surgery declined by 2% (95% CI: 1.9, 3.0), from 15.7% at the baseline to 13.3% at 3 months. Generally, improvements in PROMs were associated with reduced likelihood of wishing for surgery, while worsening was associated with increased likelihood. For pain, activity impairment EQ-5D and KOOS/HOOS QoL, a worsening led to a change in the probability of wish for surgery of larger absolute magnitude than an improvement in the same PROM. CONCLUSIONS: Within-person improvements in PROMs are associated with reduced wish for surgery while worsenings with an increased wish for surgery. Larger improvements in PROMs may be needed to match the magnitude of the change in wish for surgery associated with a worsening in the same PROM.
Subject(s)
Osteoarthritis, Knee , Quality of Life , Humans , Retrospective Studies , Osteoarthritis, Knee/surgery , Pain , Patient Reported Outcome Measures , Treatment OutcomeABSTRACT
OBJECTIVE: To explore how lifestyle and demographic, socioeconomic, and disease-related factors are associated with supervised exercise adherence in an osteoarthritis (OA) management program and the ability of these factors to explain exercise adherence. METHODS: A cohort register-based study on participants from the Swedish Osteoarthritis Registry who attended the exercise part of a nationwide Swedish OA management program. We ran a multinomial logistic regression to determine the association of exercise adherence with the abovementioned factors. We calculated their ability to explain exercise adherence with the McFadden R2 . RESULTS: Our sample comprises 19,750 participants (73% female, mean ± SD age 67 ± 8.9 years). Among them, 5,862 (30%) reached a low level of adherence, 3,947 (20%) a medium level, and 9,941 (50%) a high level. After a listwise deletion, the analysis was run on 16,685 participants (85%), with low levels of adherence as the reference category. Some factors were positively associated with high levels of adherence, such as older age (relative risk ratio [RRR] 1.01 [95% confidence interval (95% CI) 1.01-1.02] per year), and the arthritis-specific self-efficacy (RRR 1.04 [95% CI 1.02-1.07] per 10-point increase). Others were negatively associated with high levels of adherence, such as female sex (RRR 0.82 [95% CI 0.75-0.89]), having a medium (RRR 0.89 [95% CI 0.81-0.98] or a high level of education (RRR 0.84 [95% CI 0.76-0.94]). Nevertheless, the investigating factors could explain 1% of the variability in exercise adherence (R2 = 0.012). CONCLUSION: Despite the associations reported above, the poorly explained variability suggests that strategies based on lifestyle and demographic, socioeconomic, and disease-related factors are unlikely to improve exercise adherence significantly.
Subject(s)
Osteoarthritis, Knee , Osteoarthritis , Humans , Female , Middle Aged , Aged , Male , Exercise Therapy , Sweden/epidemiology , Osteoarthritis/diagnosis , Osteoarthritis/therapy , Exercise , Registries , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/therapyABSTRACT
OBJECTIVE: To investigate the trajectories of work and activity impairments among people participating in a digital self-management program for osteoarthritis (OA). METHODS: We conducted an observational longitudinal study using data for baseline, 3, 6, 9 and 12 months follow ups from people participating in a digital OA treatment between June 2018 and September 2021. The Work Productivity and Activity Impairment-Osteoarthritis (WPAI-OA) questionnaire was used to measure work and activity impairments. We applied linear mixed models and group-based trajectory modelling (GBTM) to assess the trajectories of work and activity impairments and their variability. Dominance analysis was performed to explore the relative importance of baseline characteristics in predicting the trajectory subgroup membership. RESULTS: A total of 14,676 participants with mean (± standard deviation) age 64.0 (± 9.1) years and 75.5% females were included. The adjusted mean improvements in work impairment from baseline were 5.8% (95% CI 5.3, 6.4) to 6.1% (95% CI 5.5, 6.8). The corresponding figures for activity impairment were 9.4% (95% CI 9.0, 9.7) to 11.3% (95% CI 10.8, 11.8). GBTM identified five (low baseline-declining, moderate baseline-declining, high baseline-declining, very high baseline-substantially declining, and very high baseline-persistent) and three (low baseline-declining, mild baseline-declining, high baseline-declining) subgroups with distinct trajectories of activity and work impairments. Dominance analysis showed that baseline pain was the most important predictor of membership in trajectory subgroups. CONCLUSION: While participation in a digital self-management program for OA was, on average, associated with improvements in work and activity impairments, there were substantial variations among the participants. Baseline pain may provide useful insights to predict trajectories of work and activity impairments.