Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Association of hypertension and diabetes with opioid initiation and progression to long-term use after osteoarthritis diagnosis : A population-based register cohort study in Sweden

Recenti, Filippo LU ; Kiadaliri, Ali LU orcid ; Battista, Simone LU orcid ; Hellberg, Clara LU ; Englund, Martin LU orcid ; Testa, Marco and Dell'Isola, Andrea LU orcid (2026) In Osteoarthritis and Cartilage Open 8(4).
Abstract

OBJECTIVE: To estimate the associations of diabetes and/or hypertension with (i) initiating opioid therapy and (ii) progressing to long-term opioid use, after an osteoarthritis (OA) diagnosis.

METHODS: Population-based open cohort study using Swedish registers. We followed 48,778 opioid-naïve individuals, aged 35-75, with incident OA between 2008 and 2019 in the Skåne region. The associations of diabetes and hypertension with first opioid dispensation (ATC: N02A) and long-term opioid use (≥90 Defined Daily Doses in one year) were analysed using flexible parametric survival models. Associations were adjusted for sociodemographic characteristics, comorbidities, and prior healthcare use.

RESULTS: At OA diagnosis, 26% of... (More)

OBJECTIVE: To estimate the associations of diabetes and/or hypertension with (i) initiating opioid therapy and (ii) progressing to long-term opioid use, after an osteoarthritis (OA) diagnosis.

METHODS: Population-based open cohort study using Swedish registers. We followed 48,778 opioid-naïve individuals, aged 35-75, with incident OA between 2008 and 2019 in the Skåne region. The associations of diabetes and hypertension with first opioid dispensation (ATC: N02A) and long-term opioid use (≥90 Defined Daily Doses in one year) were analysed using flexible parametric survival models. Associations were adjusted for sociodemographic characteristics, comorbidities, and prior healthcare use.

RESULTS: At OA diagnosis, 26% of individuals had hypertension alone, 3% diabetes alone, and 6% both; 3% developed diabetes during follow-up time, 8% hypertension. Compared to metabolically healthy individuals, the risk of a first opioid dispensation was higher only for those with hypertension alone (RR: 1.16 [95% CI 1.12; 1.20]) and both conditions (RR: 1.15 [1.10; 1.21]). All metabolic conditions were associated with a higher risk of long-term opioid use: diabetes alone (RR: 1.63 [1.21; 2.20]), hypertension alone (RR: 1.32 [1.14; 1.52]), and both (RR: 1.69 [1.42; 2.02]). The instant risk peaked in the first year post-diagnosis, and the cumulative risk was highest in comorbid groups for both outcomes (47.5% and 4.6% with both conditions vs 39.0% and 2.5% with none).

CONCLUSION: After OA diagnosis, hypertension and/or diabetes were associated with an increased risk of initiating opioid therapy and progressing to long-term use. Our findings underscore the need to develop safer OA management strategies for individuals with comorbidities.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Osteoarthritis and Cartilage Open
volume
8
issue
4
article number
100860
publisher
Elsevier
external identifiers
  • scopus:105047971007
  • pmid:42676841
ISSN
2665-9131
DOI
10.1016/j.ocarto.2026.100860
language
English
LU publication?
yes
additional info
© 2026 The Authors.
id
1eeb3a31-342d-47bf-b0d8-9cd73953c763
date added to LUP
2026-10-02 10:05:31
date last changed
2026-10-03 04:01:55
@article{1eeb3a31-342d-47bf-b0d8-9cd73953c763,
  abstract     = {{<p>OBJECTIVE: To estimate the associations of diabetes and/or hypertension with (i) initiating opioid therapy and (ii) progressing to long-term opioid use, after an osteoarthritis (OA) diagnosis.</p><p>METHODS: Population-based open cohort study using Swedish registers. We followed 48,778 opioid-naïve individuals, aged 35-75, with incident OA between 2008 and 2019 in the Skåne region. The associations of diabetes and hypertension with first opioid dispensation (ATC: N02A) and long-term opioid use (≥90 Defined Daily Doses in one year) were analysed using flexible parametric survival models. Associations were adjusted for sociodemographic characteristics, comorbidities, and prior healthcare use.</p><p>RESULTS: At OA diagnosis, 26% of individuals had hypertension alone, 3% diabetes alone, and 6% both; 3% developed diabetes during follow-up time, 8% hypertension. Compared to metabolically healthy individuals, the risk of a first opioid dispensation was higher only for those with hypertension alone (RR: 1.16 [95% CI 1.12; 1.20]) and both conditions (RR: 1.15 [1.10; 1.21]). All metabolic conditions were associated with a higher risk of long-term opioid use: diabetes alone (RR: 1.63 [1.21; 2.20]), hypertension alone (RR: 1.32 [1.14; 1.52]), and both (RR: 1.69 [1.42; 2.02]). The instant risk peaked in the first year post-diagnosis, and the cumulative risk was highest in comorbid groups for both outcomes (47.5% and 4.6% with both conditions vs 39.0% and 2.5% with none).</p><p>CONCLUSION: After OA diagnosis, hypertension and/or diabetes were associated with an increased risk of initiating opioid therapy and progressing to long-term use. Our findings underscore the need to develop safer OA management strategies for individuals with comorbidities.</p>}},
  author       = {{Recenti, Filippo and Kiadaliri, Ali and Battista, Simone and Hellberg, Clara and Englund, Martin and Testa, Marco and Dell'Isola, Andrea}},
  issn         = {{2665-9131}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{Elsevier}},
  series       = {{Osteoarthritis and Cartilage Open}},
  title        = {{Association of hypertension and diabetes with opioid initiation and progression to long-term use after osteoarthritis diagnosis : A population-based register cohort study in Sweden}},
  url          = {{http://dx.doi.org/10.1016/j.ocarto.2026.100860}},
  doi          = {{10.1016/j.ocarto.2026.100860}},
  volume       = {{8}},
  year         = {{2026}},
}