Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
BMJ Open. 2019 Nov 21;9(11):e033334. doi: 10.1136/bmjopen-2019-033334.
The purpose of this study is to estimate the prevalence of comorbidities among people with osteoarthritis (OA) using administrative health data.
Retrospective cohort analysis.
All residents in the province of Alberta, Canada registered with the Alberta Health Care Insurance Plan population registry.
497 362 people with OA as defined by 'having at least one OA-related hospitalization, or at least two OA-related physician visits or two ambulatory care visits within two years'.
We selected eight comorbidities based on literature review, clinical consultation and the availability of validated case definitions to estimate their frequencies at the time of diagnosis of OA. Sex-stratified age-standardised prevalence rates per 1000 population of eight clinically relevant comorbidities were calculated using direct standardisation with 95% CIs. We applied χ tests of independence with a Bonferroni correction to compare the percentage of comorbid conditions in each age group.
54.6% (n=2 71 794) of people meeting the OA case definition had at least one of the eight selected comorbidities. Females had a significantly higher rate of comorbidities compared with males (standardised rates ratio=1.26, 95% CI 1.25 to 1.28). Depression, chronic obstructive pulmonary disease (COPD) and hypertension were the most prevalent in both females and males after age-standardisation, with 40% of all cases having any combination of these comorbidities. We observed a significant difference in the percentage of comorbidities among age groups, illustrated by the youngest age group (<45 years) having the highest percentage of cases with depression (24.6%), compared with a frequency of 16.1% in those >65 years.
Our findings highlight the high frequency of comorbidity in people with OA, with depression having the highest age-standardised prevalence rate. Comorbidities differentially affect females, and vary by age. These factors should inform healthcare programme and delivery.
本研究旨在利用医疗保健数据估计患有骨关节炎（OA）人群的合并症患病率。
回顾性队列分析。
加拿大艾伯塔省的所有居民，他们在艾伯塔省医疗保健保险计划人群登记处注册。
497362 名 OA 患者，其定义为“至少有一次 OA 相关住院治疗，或在两年内至少有两次 OA 相关就诊或两次门诊就诊”。
我们根据文献回顾、临床咨询和已验证的病例定义的可用性，选择了 8 种合并症，以估计在 OA 诊断时它们的发生频率。使用直接标准化方法，以 95%置信区间计算 8 种临床相关合并症每 1000 人的性别分层年龄标准化患病率。我们应用 χ 检验独立性和 Bonferroni 校正，以比较每个年龄组的合并症百分比。
符合 OA 病例定义的 54.6%（n=271794）的人至少有一种选定的合并症。与男性相比，女性的合并症发生率明显更高（标准化率比=1.26，95%CI 1.25 至 1.28）。在年龄标准化后，抑郁症、慢性阻塞性肺疾病（COPD）和高血压在女性和男性中是最常见的合并症，所有病例中有 40%有这些合并症的任意组合。我们观察到各年龄组的合并症百分比存在显著差异，年龄最小的年龄组（<45 岁）中患有抑郁症的病例比例最高（24.6%），而年龄最大的年龄组（>65 岁）的频率为 16.1%。
我们的研究结果突出了 OA 患者中合并症的高频率，其中抑郁症的年龄标准化患病率最高。合并症对女性有不同的影响，并随年龄而变化。这些因素应告知医疗保健计划和提供。
