AB1663 MUSCULOSKELETAL (MSK) PAIN IN VILLAGE BHIGWAN (INDIA) IN 2022- CHANGE OVER 25 YEARS: WHO COMMUNITY ORIENTED PROGRAM FOR CONTROL OF RHEUMATIC DISEASES (COPCORD) 1996-2022

Abstract

BackgroundCOPCORD population surveys (Stage I) have reported the prevalence of MSK pain and rheumatic disorders in several countries. A crude point prevalence rate of 18.2% for MSK pain (adult) was reported by the maiden COPCORD India survey (1996) in rural Bhigwan (Pune) and was continued to date with a free-of-cost local rheumatology clinic and a health education program. Several other factors (development, environment, Chikungunya epidemic 2006, Covid pandemic 2019) are likely to impact the epidemiology of MSK disorders and thus we carried out a resurvey in Bhigwan from April to July 2022. We present early results of MSK pain and related factors.ObjectivesTo describe and measure the current MSK pain and rheumatic disorders in Bhigwan rural population and further assess the transformation over time (1996 to 2022).MethodsThe resurvey (Stage I) was carried out using the methods of the previous survey (Bhigwan COPCORD model 1996). Trained voluntary health workers (HW) completed a house-to-house cross-sectional survey (Phase 1) of the adult population(≥ 18 years) and identified current and/or past MSK pain respondents. Pain due to recent trauma (< 3 months) was excluded. Concurrently, the respondents were also evaluated (Phase 2) for pain descriptors and other relevant issues. Rheumatologists examined (Phase 3) the respondents to make a clinical diagnosis, order relevant investigations, and begin treatment. A follow-up was scheduled. The target population was estimated at 8117 (Government records). The database was created using an indigenous software program. Standard population analysis was carried out. Crude point prevalence rates (95% confidence intervals) are presented. Further analysis is being done.Results6970 population (85.9% response, 50% males) was surveyed. The age-gender distribution pattern was comparable with the India rural census 2011; 63% in 18-44 years age groups (Bhigwan). Paradoxically, only 7.6% current population in sharp contrast to about 55% in 1996 admitted working (physically) in fields; now dependent upon temporary migrant labor (not in the survey). 32% population possessed mobile phones. Five hundred eighty-six pain respondents (women 69%) were identified; 46% belonged to the 45-64 years age group. The MSK pain prevalence was 8.2% (7.5%, 8.8 %); male 2.5 (2.2 %,2.9%). female 5.6% (5.1, 6.2). 14.2% population used tobacco in some form, mostly oral; 36.3% of MSK pain respondents (58% women). Hypertension in 7.9%, diabetes in 4.7%, thyroid disorders in 1.6%, and rectal hemorrhoids in 1% was self-reported in the population; correspondingly 25%, 12%, 2.5%, and 3% were reported by the MSK pain cohort. Past history of Chikungunya in 5.7% and COVID-19 in 7.4% of the total population was reported. On univariate analysis, MSK pain was significantly associated (p < 0.0001, Chi-square) with Chikungunya, COVID-19, tobacco use, fieldwork, and low education status. Prevalence rates for disease groups were 1.38% (1.12. 1.68) for inflammatory arthritis, 3.66% (3.23, 4.13) for degenerative arthritis and 2.87 % (2.49, 3.29) for non-specific rheumatism/arthritis. Self-reported data, subject recall, and limited investigations were important concerns.ConclusionThe current COPCORD survey shows that despite a substantial reduction from 1996, MSK pain continues to be a predominant and important self-reported illness in the Bhigwan rural community. Undoubtedly, the lives and livelihoods of the Bhigwan people and their MSK landscape have been transformed substantially. Interestingly, the burden of other non-communicable diseases seems increased. Further research studies will be required to unravel the role of Chikungunya and COVID-19, and other risk factors in MSK disorders.