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Research

Prevalence and management of osteoarthritis in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

Richard Birtwhistle, Rachael Morkem, George Peat, Tyler Williamson, Michael E. Green, Shahriar Khan and Kelvin P. Jordan
July 30, 2015 3 (3) E270-E275; DOI: https://doi.org/10.9778/cmajo.20150018
Richard Birtwhistle
1Centre for Studies in Primary Care, Department of Family Medicine, Queen’s University, Kingston, Ont.
2Department of Public Health Sciences, Queen’s University, Kingston, Ont.
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Rachael Morkem
1Centre for Studies in Primary Care, Department of Family Medicine, Queen’s University, Kingston, Ont.
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George Peat
3Arthiritis Research UK Primary Care Centre, Institute for Primary Care Sciences, Keele University, Staffordshire, UK
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Tyler Williamson
4Department of Community Health Sciences, University of Calgary, Calgary, Alta.
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Michael E. Green
1Centre for Studies in Primary Care, Department of Family Medicine, Queen’s University, Kingston, Ont.
2Department of Public Health Sciences, Queen’s University, Kingston, Ont.
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Shahriar Khan
1Centre for Studies in Primary Care, Department of Family Medicine, Queen’s University, Kingston, Ont.
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Kelvin P. Jordan
3Arthiritis Research UK Primary Care Centre, Institute for Primary Care Sciences, Keele University, Staffordshire, UK
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    Figure 1:

    Prevalence of osteoarthritis diagnoses in electronic medical records by patient age and sex.

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    Table 1: Characteristics of the study population
    CharacteristicNo. (%)*
    Patients with osteoarthritis
    n = 29 562†
    Patients without osteoarthritis
    n = 207 610†
    Age, yr, mean ± SD67.4(13.4)53.5(15.7)
    Sex
    Male10 807(36.6)76 265(42.8)
    Female18 755(63.4)101 783(57.2)
    Residence
    Urban22 094(76.0)133 508(77.3)
    Rural6 979(24.0)39 137(22.7)
    No. of comorbid conditions†
    09 549(32.3)101 470(57.0)
    111 658(39.4)54 393(30.6)
    26 086(20.6)17 802(10.0)
    31 840(6.2)3 766(2.1)
    ≥ 4429(1.5)617(0.3)

    Note: SD = standard deviation. 
*Unless stated otherwise.
†Limited to other conditions for which the Canadian Primary Care Sentinel Surveillance Network has validated algorithms (i.e., hypertension, chronic obstructive pulmonary disease, diabetes mellitus, depression, epilepsy, Parkinson disease and dementia).

      • View popup
      Table 2: Prevalence of osteoarthritis by patient age and sex
      Age group, yrNo. (%)*
      MenWomenOverall
      30–3914 516(1.9)23 839(1.5)38 355(1.6)
      40–4917 508(4.9)24 836(5.1)42 344(5.0)
      50–5920 562(10.8)26 812(14.0)47 374(12.6)
      60–6917 208(16.7)20 798(23.4)38 006(20.4)
      70–7910 446(24.2)13 316(32.7)23 762(29.0)
      80+6 832(30.0)10 937(38.2)17 769(35.1)
      Overall87 072(12.4)12 0538(15.6)207 610(14.2)

      *Direct age–sex-standardized prevalence estimates according to the Canadian national age–sex distribution based on data from the 2011 census.

        • View popup
        Table 3: Prevalence ratios for osteoarthritis adjusted for age and sex, by location of residence, BMI and smoking status
        Characteristic*PR (95% CI)p value
        Location (n = 201 718)
        Urban = ref1.00—
        Rural0.99 (0.96–1.01)0.3
        BMI group (n = 136 765)
        Underweight (< 18)1.11 (1.04–1.17)< 0.001
        Normal (18–24) = ref1.00—
        Overweight (25–29)†1.04 (1.01–1.07)0.004
        Obese (> = 30)‡1.14 (1.11–1.17)< 0.001
        Smoking n = 85 705
        Never = ref1.00—
        Past0.98 (0.95–1.01)0.2
        Current0.90 (0.86–0.94)< 0.001

        Note: BMI = body mass index, CI = confidence interval, PR = prevalence ratio.
*Location data missing for 5 892 (2.8%) patients; BMI data missing for 7 388 (25%) patients with osteoarthritis and 64 910 (36.5%) patients without osteoarthritis; smoking data missing for 15 980 (54%) patients with osteoarthritis and 105 925 (59.5%) patients without osteoarthritis.
†p < 0.01.
‡p < 0.001.

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          Table 4: Age- and sex-adjusted prevalence ratios for comorbidity among patients with osteoarthritis
          ComorbidityPR (95% CI)p value
          Hypertension1.17 (1.15–1.19)< 0.001
          Diabetes1.02 (0.99–1.05)NS
          Depression1.26 (1.22–1.30)< 0.001
          COPD1.16 (1.11–1.21)< 0.001
          Dementia1.00 (0.95–1.06)NS
          Epilepsy1.27 (1.13–1.43)< 0.001
          Parkinsonism1.08 (0.93–1.24)NS

          Note: CI = confidence interval, COPD = chronic obstructive pulmonary disease, NS = not significant, PR = prevalence ratio.

            • View popup
            Table 5: Prevalence of osteoarthritis by number of other conditions (i.e., multimorbidity)
            No. of other conditionsOsteoarthritis present, %
            n = 29 562
            Osteoarthritis absent, %
            n = 178 048
            032.357.0
            139.430.6
            220.610.0
            36.22.1
            4 or more1.50.3
            Total100.0100.0
            • View popup
            Table 6: Use of medications among patients with osteoarthritis (n = 29 562)
            Drug classPatients, no. (%)AgentPatients, no. (%)
            Acetaminophen (alone or in combination)7 424(25.1)Acetaminophen alone4 725(16.0)
            Acetaminophen in combination2 699(9.1)
            NSAIDs16 732(56.6)Celecoxib5 022(17.0)
            Diclofenac*8 752(29.6)
            Ibuprofen1 210(4.1)
            Meloxicam1 963(6.6)
            Naproxen5 885(19.9)
            Other NSAIDs†3 023(10.2)
            Narcotics9 761(33.0)Codeine6 881(23.3)
            Hydrocodone462(1.6)
            Hydromorphone1 164(3.9)
            Morphine784(2.7)
            Oxycodone1 488(5.0)
            Tramadol2 299(7.8)

            Note: NSAID = nonsteroidal anti-inflammatory drug.
*There were 4 808 patients with prescriptions for diclofenac, about 45% of which were in the form of topical gel or cream.
†Diflunisal, etodolac, floctafenine, flurbiprofen, indometacin, ketoprofen, ketorolac, lumiracoxib, nabumetone, piroxicam, rofecoxib, sulindac, tiaprofenic acid and valdecoxib.

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            CMAJ Open: 3 (3)
            Vol. 3, Issue 3
            17 Jul 2015
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            Prevalence and management of osteoarthritis in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network
            Richard Birtwhistle, Rachael Morkem, George Peat, Tyler Williamson, Michael E. Green, Shahriar Khan, Kelvin P. Jordan
            Jan 2015, 3 (3) E270-E275; DOI: 10.9778/cmajo.20150018

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            Prevalence and management of osteoarthritis in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network
            Richard Birtwhistle, Rachael Morkem, George Peat, Tyler Williamson, Michael E. Green, Shahriar Khan, Kelvin P. Jordan
            Jan 2015, 3 (3) E270-E275; DOI: 10.9778/cmajo.20150018
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