Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Assistant Professor, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Bone Joint J. 2020 Mar;102-B(3):352-359. doi: 10.1302/0301-620X.102B3.BJJ-2019-0875.R1.
Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort.
A population-based cohort of people aged between 40 and 69 years in the UK (the UK Biobank) was studied. People who underwent surgery for RCD were identified through a link with NHS inpatient records covering a mean of eight years after enrolment. Multivariate Cox proportional hazards regression was used to calculate hazard ratios (HRs) as estimates of associations with surgery for RCD accounting for confounders. The risk factors which were considered included age, sex, race, education, Townsend deprivation index, body mass index (BMI), occupational demands, and exposure to smoking.
Of the 421,894 people who were included, 47% were male. The mean age at the time of enrolment was 56 years (40 to 69). A total of 2,156 people were identified who underwent surgery for RCD. Each decade increase in age was associated with a 55% increase in the incidence of RCD surgery (95% confidence interval (CI) 46% to 64%). Male sex, non-white race, lower deprivation score, and higher BMI were significantly associated with a higher risk of surgery for RCD (all p < 0.050). Greater occupational physical demands were significantly associated with higher rates of RCD surgery (HR = 2.1, 1.8, and 1.4 for 'always', 'usually', and 'sometimes' doing heavy manual labour vs 'never', all p < 0.001). Former smokers had significantly higher rates of RCD surgery than those who had never smoked (HR 1.23 (95% CI 1.12 to 1.35), p < 0.001), while current smokers had similar rates to those who had never smoked (HR 0.94 (95% CI 0.80 to 1.11)). Among those who had never smoked, the risk of surgery was higher among those with more than one household member who smoked (HR 1.78 (95% CI 1.08 to 2.92)). The risk of RCD surgery was not significantly related to other measurements of secondhand smoking.
Many factors were independently associated with surgery for RCD, including older age, male sex, higher BMI, lower deprivation score, and higher occupational physical demands. Several of the risk factors which were identified are modifiable, suggesting that the healthcare burden of RCD might be reduced through the pursuit of public health goals, such as reducing obesity and modifying occupational demands. Cite this article: 2020;102-B(3):352-359.
肩袖疾病（RCD）的少数危险因素和相应的治疗方法尚未得到明确确立。本研究的目的是在大型队列中评估许多危险因素与 RCD 手术发生率之间的关系。
对英国（英国生物银行）40 至 69 岁之间的人群进行了一项基于人群的队列研究。通过与 NHS 住院记录建立联系，确定了接受 RCD 手术的患者，该记录涵盖了登记后平均 8 年的时间。多变量 Cox 比例风险回归用于计算风险比（HR），作为与 RCD 手术相关的关联的估计值，同时考虑了混杂因素。考虑的危险因素包括年龄、性别、种族、教育程度、汤森德贫困指数、体重指数（BMI）、职业需求以及吸烟暴露。
在纳入的 421894 人中，有 47％为男性。登记时的平均年龄为 56 岁（40 至 69 岁）。共有 2156 人被确定接受了 RCD 手术。年龄每增加十年，RCD 手术的发生率就会增加 55％（95％置信区间（CI）为 46％至 64％）。男性，非白种人，较低的贫困评分和较高的 BMI 与 RCD 手术的风险显着增加有关（均 p <0.050）。较高的职业体力需求与 RCD 手术的发生率显着相关（“总是”，“通常”和“有时”进行繁重的体力劳动的 HR 分别为 2.1、1.8 和 1.4，与“从不”相比，均 p <0.001）。与从不吸烟的人相比，曾经吸烟的人 RCD 手术的比率明显更高（HR 1.23（95％CI 1.12 至 1.35），p <0.001），而当前吸烟者的比率与从不吸烟的人相似（HR 0.94（95％CI 0.80 至 1.11））。在从不吸烟的人中，有一个以上家庭成员吸烟的人手术风险更高（HR 1.78（95％CI 1.08 至 2.92））。RCD 手术的风险与其他二手烟测量值之间没有明显的关系。
许多因素与 RCD 手术独立相关，包括年龄较大，男性，BMI 较高，贫困程度较低和职业体力需求较高。确定的一些危险因素是可以改变的，这表明通过追求公共卫生目标（例如减少肥胖和改变职业需求），可能会降低 RCD 的医疗负担。
