Prevalence of osteoarthritis in lower middle- and low-income countries: a systematic review and meta-analysis

Ismail Yahaya,Toby Helliwell,Christian D Mallen,Opeyemi O Babatunde,Tanya Wright,Lisa Dikomitis,Nadia Corp

doi:10.1007/s00296-021-04838-y

Abstract

Evidence from the Global Burden of Disease studies suggests that osteoarthritis (OA) is a significant cause of disability globally; however, it is less clear how much of this burden exists in low-income and lower middle-income countries. This study aims to determine the prevalence of OA in people living in low-income and lower middle-income countries. Four electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science) were systematically searched from inception to October 2018 for population-based studies. We included studies reporting the prevalence of OA among people aged 15 years and over in low-income and lower middle-income countries. The prevalence estimates were pooled across studies using random effects meta-analysis. Our study was registered with PROSPERO, number CRD42018112870.The search identified 7414 articles, of which 356 articles were selected for full text assessment. 34 studies were eligible and included in the systematic review and meta-analysis. The pooled prevalence of OA was 16·05% (95% confidence interval (CI) 12·55–19·89), with studies demonstrating a substantial degree of heterogeneity (I2 = 99·50%). The pooled prevalence of OA was 16.4% (CI 11·60–21.78%) in South Asia, 15.7% (CI 5·31–30·25%) in East Asia and Pacific, and 14.2% (CI 7·95–21·89%) in Sub Saharan Africa. The meta-regression analysis showed that publication year, study sample size, risk of bias score and country-income categories were significantly associated with the variations in the prevalence estimates. The prevalence of OA is high in low-income and lower middle-income countries, with almost one in six of the study participants reported to have OA. With the changing population demographics and the shift to the emergence of non-communicable diseases, targeted public health strategies are urgently needed to address this growing epidemic in the aging population.

Highlights

Low- and middle-income countries (LMICs) are experiencing a dramatic shift in the burden of disease from communicable to non-communicable disease (NCD) [1]
NCDs accounted for 61% of global disability adjusted life years (DALYs) in 2016, around 20% higher than in 1990, [3] with the highest rise observed in LMICs settings
This systematic review of the prevalence of OA in lower middle- and low-income countries has brought together evidence from 34 cross-sectional studies from the last 25 years, incorporating 80,000 participants. These studies were unevenly distributed with Nigeria and India, both lower middle income countries, accounting for about a third of the included studies. It is one of the first systematic reviews undertaken investigating the prevalence of OA in lower middle- and low-income countries

Summary

Introduction

Low- and middle-income countries (LMICs) are experiencing a dramatic shift in the burden of disease from communicable to non-communicable disease (NCD) [1]. This is causing a significant challenge for governments and health care systems that are already strained due to the epidemics associated with HIV/AIDS, other infectious diseases and weak health systems. NCDs accounted for 61% of global disability adjusted life years (DALYs) in 2016, around 20% higher than in 1990, [3] with the highest rise observed in LMICs settings. The Global Burden of Disease (GBD) study (2015) ranked OA and diabetes highest in terms of largest increase in years lived with disability when compared to the other top causes of disability [6]

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