Temporal relationship between osteoarthritis and comorbidities: a combined case control and cohort study in the United Kingdom primary care setting

Swain, S.; Coupland, C.; Mallen, C.; Kuo, C. Fu; Sarmanova, A.; Doherty, M.; Zhang, W.

Abstract

Purpose: To determine the temporal relationship between osteoarthritis (OA) and comorbidities.

Methods: During a 20 years period (1997-2017), we identified 222,290 incident OA cases and 222,290 age (+/-2 years), sex and practice matched controls (non-OA) from the UK Clinical Practice Research Datalink (CPRD). Controls were assigned with an index date, same as OA diagnosis date in matched cases. For the follow-up analysis, 27,932 incident OA patients and 27,932 age (+/-2 years), sex and practice matched controls without selected comorbidities at or before OA diagnosis were identified. The association (Odds Ratio (ORs)) of OA with 47 identified comorbidities and with multi-morbidity (>2 comorbidities) prior to diagnosis, and the risks (hazard ratio (HRs)) of developing these comorbidities after OA diagnosis, were estimated and adjusted for age, sex, diagnosis year, body mass index, smoking and alcohol consumption. The false discovery rate method was used to obtain adjusted P values to account for multiple testing.

Results: Within the 20 years observational period prior to the index date, the prevalence of multi-morbidity among OA cases and controls was 53.1% and 41.8% respectively. The adjusted OR was 1.71 (95% CI 1.69-1.74). Of 47 chronic conditions studied, 39 had significant associations with OA before the diagnosis, including rheumatoid arthritis, fibromyalgia, polymyalgia, back pain, Sjogren’s syndrome, systemic lupus erythematosus, ankylosing spondylitis, gout, heart failure, depression and peripheral vascular diseases. [Figure 1] After the index date, the median time to develop multi-morbidity was 7 years in people with OA whereas it was 9 years in people without OA. The adjusted HR was 1.43 (95% CI 1.32-1.54). The cumulative probabilities of having at least two comorbidities at 5 years, 15 years and 20 years following the index date were 0.64%, 22.14% and 52.93% in patients with incident OA and 0.25%, 15.53% and 38.00% in controls, respectively [Figure 2] Patients with incident OA were significantly more likely to develop 21 comorbidities than non-OA controls. Leading comorbidities were fibromyalgia, rheumatoid arthritis, dementia, ankylosing spondylitis, sleep problems, benign prostate disease, anaemia, crystal arthropathy, peripheral vascular disease, depression, gall bladder disease and cancer. [Figure 1]

Conclusions: The burden of comorbidity is higher in people with OA, both at and after the initial diagnosis, than people without OA. The temporal association reported merits further investigation with regard to causality.

Citation

Swain, S., Coupland, C., Mallen, C., Kuo, C. F., Sarmanova, A., Doherty, M., & Zhang, W. (2020). Temporal relationship between osteoarthritis and comorbidities: a combined case control and cohort study in the United Kingdom primary care setting. Osteoarthritis and Cartilage, 28, S72-S73. https://doi.org/10.1016/j.joca.2020.02.110

• Journal Article Type: Conference Paper
• Conference Name: 2020 OARSI World Congress on Osteoarthritis; 30 April-3 May 2020
• Conference Location: Messe Wien Exhibition & Congress Center, Vienna, Austria
• Online Publication Date: Apr 20, 2020
• Publication Date: 2020-04
• Deposit Date: Jun 28, 2023
• Journal: Osteoarthritis and Cartilage
• Print ISSN: 1063-4584
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 28
• Pages: S72-S73
• DOI: https://doi.org/10.1016/j.joca.2020.02.110
• Keywords: Orthopedics and Sports Medicine; Biomedical Engineering; Rheumatology