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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

Yu, Dahai; Jordan, Kelvin P.; Bedson, John; Englund, Martin LU ; Blyth, Fiona; Turkiewicz, Aleksandra LU ; Prieto-Alhambra, Daniel and Peat, George (2017) In Rheumatology1999-01-01+01:00 56(11). p.1902-1917
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... (More)

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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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
analgesics, incidence, osteoarthritis, primary care
in
Rheumatology1999-01-01+01:00
volume
56
issue
11
pages
16 pages
publisher
Oxford University Press
external identifiers
  • scopus:85032809102
  • wos:000413543900012
ISSN
1462-0332
DOI
10.1093/rheumatology/kex270
language
English
LU publication?
yes
id
5c85179e-b7ab-4b36-a71b-d6dba4a12e31
date added to LUP
2017-11-22 14:29:52
date last changed
2018-01-16 13:26:22
@article{5c85179e-b7ab-4b36-a71b-d6dba4a12e31,
  abstract     = {<p>Objective: To determine recent trends in the rate and management of new cases of OA presenting to primary healthcare using UK nationally representative data.</p><p>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.</p><p>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).</p><p>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.</p>},
  author       = {Yu, Dahai and Jordan, Kelvin P. and Bedson, John and Englund, Martin and Blyth, Fiona and Turkiewicz, Aleksandra and Prieto-Alhambra, Daniel and Peat, George},
  issn         = {1462-0332},
  keyword      = {analgesics,incidence,osteoarthritis,primary care},
  language     = {eng},
  month        = {11},
  number       = {11},
  pages        = {1902--1917},
  publisher    = {Oxford University Press},
  series       = {Rheumatology1999-01-01+01:00},
  title        = {Population trends in the incidence and initial management of osteoarthritis : age-period-cohort analysis of the Clinical Practice Research Datalink, 1992-2013},
  url          = {http://dx.doi.org/10.1093/rheumatology/kex270},
  volume       = {56},
  year         = {2017},
}