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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; Bedson, John; Englund, Martin; Blyth, Fiona; Turkiewicz, Aleksandra; Prieto-Alhambra, Daniel; Peat, George

Population trends in the incidence and initial management of osteoarthritis: age-period-cohort analysis of the Clinical Practice Research Datalink, 1992–2013 Thumbnail


Authors

John Bedson

Martin Englund

Fiona Blyth

Aleksandra Turkiewicz

Daniel Prieto-Alhambra

George Peat



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 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.

Citation

Yu, D., Jordan, K., Bedson, J., Englund, M., Blyth, F., Turkiewicz, A., …Peat, G. (2017). Population trends in the incidence and initial management of osteoarthritis: age-period-cohort analysis of the Clinical Practice Research Datalink, 1992–2013. Rheumatology, 56(11), 1902-1917. https://doi.org/10.1093/rheumatology/kex270

Journal Article Type Article
Acceptance Date Jun 9, 2017
Online Publication Date Aug 4, 2017
Publication Date Aug 4, 2017
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 56
Issue 11
Pages 1902-1917
DOI https://doi.org/10.1093/rheumatology/kex270
Keywords osteoarthritis; incidence; primary care; analgesics
Publisher URL https://academic.oup.com/rheumatology/article/doi/10.1093/rheumatology/kex270/4065207/Population-trends-in-the-incidence-and-initial

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