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Socioeconomic inequalities of the hand infections pyogenic flexor tenosynovitis and septic arthritis and risk of opioid overuse following diagnosis : a registry-based nationwide retrospective cohort study in Sweden

Lundén, Karolin LU orcid ; Perez, Raquel LU orcid ; Zimmerman, Malin LU orcid ; Merlo, Juan LU orcid and Dahlin, Lars B. LU orcid (2026) In BMJ Open 16(1).
Abstract

Objectives To examine the associations between socioeconomic position (SEP) and the incidence of serious hand infections—pyogenic flexor tenosynovitis (PFT) and septic arthritis (SA)—as well as risks of opioid overuse following diagnosis using nation-level data. Design In a registry-based nationwide retrospective cohort study, (1) associations between SEP and incidence of PFT/SA; (2) SEP and infection-type effects on opioid overuse in the general population and (3) SEP and clinical predictors of opioid overuse among individuals diagnosed with PFT/SA were examined. Participants and outcome measures Using linked Swedish national registers (2010–2015), (1) a multinomial regression to assess SEP and infection risk (n=5 697 865); (2)... (More)

Objectives To examine the associations between socioeconomic position (SEP) and the incidence of serious hand infections—pyogenic flexor tenosynovitis (PFT) and septic arthritis (SA)—as well as risks of opioid overuse following diagnosis using nation-level data. Design In a registry-based nationwide retrospective cohort study, (1) associations between SEP and incidence of PFT/SA; (2) SEP and infection-type effects on opioid overuse in the general population and (3) SEP and clinical predictors of opioid overuse among individuals diagnosed with PFT/SA were examined. Participants and outcome measures Using linked Swedish national registers (2010–2015), (1) a multinomial regression to assess SEP and infection risk (n=5 697 865); (2) logistic regression on opioid overuse (≥2 dispensations within 3 months) related to SEP and infection status and (3) a restricted analysis among diagnosed individuals (n=3701) to isolate clinical determinants of opioid overuse was conducted. Results Among the study population, 0.04% had PFT and 0.02% had SA. In the general population, 0.31% received two or more opioid prescriptions, compared with 4.5% of those with PFT and 6.8% of those with SA. Male sex, older age, being native, low occupational qualification, comorbidity and—specifically for SA—low income were associated with higher infection risk. Both infections independently predicted opioid overuse (adjusted OR for PFT: 13.23 (95% CI 10.92 to 16.02); adjusted OR for SA: 15.16 (11.99 to 19.17)). Additional predictors of overuse included low SEP, female sex, older age, native birth, living alone and comorbidity. Infected individuals with SA were more likely to overuse opioids than those with PFT, but SEP had limited predictive power within this subgroup. Conclusions Despite universal healthcare, socioeconomic disparities exist in hand infection incidence and opioid prescribing. PFT and SA increase the risk of opioid overuse, but SE inequalities, except comorbidity, are less relevant among individuals. Targeted, equitable pain management strategies that reduce unnecessary opioid exposure while ensuring adequate care are needed.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Drug Therapy, Epidemiology, Hand & wrist, Pain management
in
BMJ Open
volume
16
issue
1
article number
e108329
publisher
BMJ Publishing Group
external identifiers
  • scopus:105029070036
  • pmid:41617232
ISSN
2044-6055
DOI
10.1136/bmjopen-2025-108329
language
English
LU publication?
yes
id
c901e5f5-594d-47cc-a581-398c0ba7f53f
date added to LUP
2026-02-19 13:04:53
date last changed
2026-05-29 03:28:36
@article{c901e5f5-594d-47cc-a581-398c0ba7f53f,
  abstract     = {{<p>Objectives To examine the associations between socioeconomic position (SEP) and the incidence of serious hand infections—pyogenic flexor tenosynovitis (PFT) and septic arthritis (SA)—as well as risks of opioid overuse following diagnosis using nation-level data. Design In a registry-based nationwide retrospective cohort study, (1) associations between SEP and incidence of PFT/SA; (2) SEP and infection-type effects on opioid overuse in the general population and (3) SEP and clinical predictors of opioid overuse among individuals diagnosed with PFT/SA were examined. Participants and outcome measures Using linked Swedish national registers (2010–2015), (1) a multinomial regression to assess SEP and infection risk (n=5 697 865); (2) logistic regression on opioid overuse (≥2 dispensations within 3 months) related to SEP and infection status and (3) a restricted analysis among diagnosed individuals (n=3701) to isolate clinical determinants of opioid overuse was conducted. Results Among the study population, 0.04% had PFT and 0.02% had SA. In the general population, 0.31% received two or more opioid prescriptions, compared with 4.5% of those with PFT and 6.8% of those with SA. Male sex, older age, being native, low occupational qualification, comorbidity and—specifically for SA—low income were associated with higher infection risk. Both infections independently predicted opioid overuse (adjusted OR for PFT: 13.23 (95% CI 10.92 to 16.02); adjusted OR for SA: 15.16 (11.99 to 19.17)). Additional predictors of overuse included low SEP, female sex, older age, native birth, living alone and comorbidity. Infected individuals with SA were more likely to overuse opioids than those with PFT, but SEP had limited predictive power within this subgroup. Conclusions Despite universal healthcare, socioeconomic disparities exist in hand infection incidence and opioid prescribing. PFT and SA increase the risk of opioid overuse, but SE inequalities, except comorbidity, are less relevant among individuals. Targeted, equitable pain management strategies that reduce unnecessary opioid exposure while ensuring adequate care are needed.</p>}},
  author       = {{Lundén, Karolin and Perez, Raquel and Zimmerman, Malin and Merlo, Juan and Dahlin, Lars B.}},
  issn         = {{2044-6055}},
  keywords     = {{Drug Therapy; Epidemiology; Hand & wrist; Pain management}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open}},
  title        = {{Socioeconomic inequalities of the hand infections pyogenic flexor tenosynovitis and septic arthritis and risk of opioid overuse following diagnosis : a registry-based nationwide retrospective cohort study in Sweden}},
  url          = {{http://dx.doi.org/10.1136/bmjopen-2025-108329}},
  doi          = {{10.1136/bmjopen-2025-108329}},
  volume       = {{16}},
  year         = {{2026}},
}