Abstract
BackgroundEquine laminitis is a complex disease that manifests as pain and lameness in the feet, often with debilitating consequences. There is a paucity of data that accounts for the multifactorial nature of laminitis and considers time-varying covariates that may be associated with disease development; particularly those that are modifiable and present potential interventions. A previous case-control study identified a number of novel, modifiable factors associated with laminitis which warranted further investigation and corroboration. The aim of this study was to identify factors associated with equine laminitis in horses/ponies in Great Britain (GB) using a prospective, web-based cohort study design, with particular interest in evaluating modifiable factors previously identified in the case-control study.ResultsSelf-selected horse/pony owners in GB submitted initial baseline and follow-up health and management questionnaires for 1070 horses/ponies between August 2014 and December 2016. The enrolled horses/ponies contributed 1068 horse-years at risk with a median of 38 days between questionnaire submissions. Owners reported 123 owner-recognised and/or veterinary-diagnosed episodes of active laminitis using a previously-validated laminitis reporting form. Multivariable Cox regression modelling identified 16 risk/protective factors associated with laminitis development. In keeping with the previous case-control study, a prior history of laminitis (particularly non-veterinary-diagnosed episodes), soreness after shoeing/trimming and weight gain were associated with higher rates of laminitis. There is now strong evidence that these risk factors should be used to guide future recommendations in disease prevention. Factors with some prior evidence of association included breed, steroidal anti-inflammatory administration, transport and worming. The modifiable factors amongst these should be the focus of future laminitis studies. The remainder of the identified factors relating to health, turnout and grazing management and feeding are novel, and require further investigation to explore their relationship with laminitis and their applicability as potential interventions.ConclusionsThis study has demonstrated a temporal relationship between a number of horse- and management-level factors and laminitis, identifying potential interventions and important risk groups for which these interventions would be of particular importance. These results serve as a sound evidence-base towards the development of strategic recommendations for the horse/pony-owning population to reduce the rate of laminitis in GB.
Highlights
Equine laminitis is a complex disease that manifests as pain and lameness in the feet, often with debilitating consequences
There remains a paucity of data that accounts for the multifactorial nature of laminitis and considers time-varying covariates that may be associated with disease development
The median duration of ownership/care was 6.7 years (IQR 2.5 to 11.9 years) and owners reported that 35.9% (CI 33.0, 38.7%) of horses/ponies had laminitis previously whilst in their care
Summary
Equine laminitis is a complex disease that manifests as pain and lameness in the feet, often with debilitating consequences. Subsequent to the systematic review, a further two cohort studies in Great Britain (GB) [7, 8] and three case-control studies in GB, Denmark and the United States and Canada [9,10,11] have contributed to laminitis epidemiology These studies have provided further evidence of an association between laminitis and metabolic factors [7], feeding [9, 11], grazing [9, 10], signalment [8,9,10], glucocorticoid administration [8, 11], co-morbidity [8, 9, 11] and obesity [9, 11]. Previous epidemiological studies of laminitis have largely relied on veterinary-diagnosed episodes, but with up to 50% of episodes reported not to be veterinary-diagnosed [12, 13], important associations may not yet have been identified
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