Trajectory of excess healthcare consultations, medication use, and work disability in newly diagnosed knee osteoarthritis: a matched longitudinal register-based study

A Kiadaliri,M Englund

doi:10.1016/j.joca.2020.12.008

Abstract

To estimate the excess healthcare use and work disability attributable to knee osteoarthritis (OA) in the first 5years following diagnosis. Among individual aged 40-80 years who resided in Skåne on 31st December 2008, we identified those with a main diagnosis of knee OA during 2009-2014 and no previous diagnosis of any OA from 1998 (n=16,888). We created a comparison cohort matched (1:1) by sex, age, and municipality from individuals with no OA diagnosis (at any site) during 1998-2016. We compared healthcare use and net disability days for 60 months following diagnosis between the two groups. We applied a survival-adjusted regression technique controlling for sociodemographic characteristics as well as pre-diagnosis outcome and comorbidity. The estimated 5-year incremental effects of knee OA per-patient were 16.8 (95% CI: 15.8, 17.7) healthcare consultations, 0.7 (0.4, 1.1) inpatient days, 420 (372, 490) defined daily dose of prescribed medications, and 21.8 (15.2, 30.0) net disability days. Primary care consultations constituted about 73% of the excess healthcare consultations. Most of these incremental effects occurred in the first year after diagnosis. Better survival in the knee OA group accounted for 0.7 (95% CI: 0.5, 0.8) and 1.4 (0.7, 2.6) of the excess healthcare consultations and net disability days, respectively. Both estimated total and incremental resources use were generally greater for women than men with knee OA. Knee OA was associated with considerable excess healthcare use and work disability independent of pre-diagnosis resources use, comorbidity, and sociodemographic characteristics.

Highlights

Osteoarthritis (OA), the most common form of arthritis, is a steadily growing disease associated with pain, disability, reduced work ability, and deteriorated quality of life1e3
We conducted a matched longitudinal register-based study using the data from following population-based registries: The Swedish Population Register (SPR), the Skåne Healthcare Register (SHR), the Swedish Prescribed Drug Register (SPDR), the Swedish Social Insurance Register (SSIR), and the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA by Swedish acronym)
About 51% of the subjects included in the study were censored prior to the 60-month of follow-up, mainly because their 60-month follow-up passed the end of study

Summary

Introduction

Osteoarthritis (OA), the most common form of arthritis, is a steadily growing disease associated with pain, disability, reduced work ability, and deteriorated quality of life1e3. According to the Global Burden of Diseases Study 2015, by accounting for 1.7% (1.3%) of total years with disability (YLDs) in women (men), OA was ranked as 16th leading cause of YLDs among 315 diseases in Sweden[4]. While OA may affect all joints, the knee and hip joints are the most commonly affected. Recent data from southern Sweden showed that 26.6% of the population aged 45 years and older had a doctor-diagnosed OA (13.8% knee OA, and 5.8% hip OA) in 20125. OA is associated with considerable increase in the use of healthcare resources[6,7].

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Discussion

Conclusion