Lancet Rheumatol. 2023 Aug 21;5(9):e508-e522. doi: 10.1016/S2665-9913(23)00163-7. eCollection 2023 Sep.
Osteoarthritis is the most common form of arthritis in adults, characterised by chronic pain and loss of mobility. Osteoarthritis most frequently occurs after age 40 years and prevalence increases steeply with age. WHO has designated 2021-30 the decade of healthy ageing, which highlights the need to address diseases such as osteoarthritis, which strongly affect functional ability and quality of life. Osteoarthritis can coexist with, and negatively effect, other chronic conditions. Here we estimate the burden of hand, hip, knee, and other sites of osteoarthritis across geographies, age, sex, and time, with forecasts of prevalence to 2050.
In this systematic analysis for the Global Burden of Disease Study, osteoarthritis prevalence in 204 countries and territories from 1990 to 2020 was estimated using data from population-based surveys from 26 countries for knee osteoarthritis, 23 countries for hip osteoarthritis, 42 countries for hand osteoarthritis, and US insurance claims for all of the osteoarthritis sites, including the other types of osteoarthritis category. The reference case definition was symptomatic, radiographically confirmed osteoarthritis. Studies using alternative definitions from the reference case definition (for example self-reported osteoarthritis) were adjusted to reference using regression models. Osteoarthritis severity distribution was obtained from a pooled meta-analysis of sources using the Western Ontario and McMaster Universities Arthritis Index. Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLDs). Prevalence was forecast to 2050 using a mixed-effects model.
Globally, 595 million (95% uncertainty interval 535-656) people had osteoarthritis in 2020, equal to 7·6% (95% UI 6·8-8·4) of the global population, and an increase of 132·2% (130·3-134·1) in total cases since 1990. Compared with 2020, cases of osteoarthritis are projected to increase 74·9% (59·4-89·9) for knee, 48·6% (35·9-67·1) for hand, 78·6% (57·7-105·3) for hip, and 95·1% (68·1-135·0) for other types of osteoarthritis by 2050. The global age-standardised rate of YLDs for total osteoarthritis was 255·0 YLDs (119·7-557·2) per 100 000 in 2020, a 9·5% (8·6-10·1) increase from 1990 (233·0 YLDs per 100 000, 109·3-510·8). For adults aged 70 years and older, osteoarthritis was the seventh ranked cause of YLDs. Age-standardised prevalence in 2020 was more than 5·5% in all world regions, ranging from 5677·4 (5029·8-6318·1) per 100 000 in southeast Asia to 8632·7 (7852·0-9469·1) per 100 000 in high-income Asia Pacific. Knee was the most common site for osteoarthritis. High BMI contributed to 20·4% (95% UI -1·7 to 36·6) of osteoarthritis. Potentially modifiable risk factors for osteoarthritis such as recreational injury prevention and occupational hazards have not yet been explored in GBD modelling.
Age-standardised YLDs attributable to osteoarthritis are continuing to rise and will lead to substantial increases in case numbers because of population growth and ageing, and because there is no effective cure for osteoarthritis. The demand on health systems for care of patients with osteoarthritis, including joint replacements, which are highly effective for late stage osteoarthritis in hips and knees, will rise in all regions, but might be out of reach and lead to further health inequity for individuals and countries unable to afford them. Much more can and should be done to prevent people getting to that late stage.
Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health.
骨关节炎是成年人中最常见的关节炎形式，其特征为慢性疼痛和活动能力丧失。骨关节炎最常发生在40岁以后，患病率随年龄急剧上升。世界卫生组织将2021年至2030年定为健康老龄化十年，这凸显了应对骨关节炎等疾病的必要性，这些疾病严重影响功能能力和生活质量。骨关节炎可与其他慢性疾病共存并产生负面影响。在此，我们估计了全球各地、不同年龄、性别和时间的手部、髋部、膝部及其他部位骨关节炎的负担，并预测了到2050年的患病率。
在这项全球疾病负担研究的系统分析中，利用来自26个国家基于人群调查的数据估计了1990年至2020年204个国家和地区的骨关节炎患病率，其中26个国家的数据用于膝骨关节炎，23个国家的数据用于髋骨关节炎，42个国家的数据用于手骨关节炎，美国保险索赔数据用于所有骨关节炎部位，包括其他类型的骨关节炎类别。参考病例定义为有症状且经影像学证实的骨关节炎。使用替代参考病例定义（如自我报告的骨关节炎）的研究通过回归模型调整为参考定义。骨关节炎严重程度分布通过对使用西安大略和麦克马斯特大学骨关节炎指数的数据源进行汇总荟萃分析获得。最终患病率估计值乘以残疾权重以计算残疾生活年数（YLDs）。使用混合效应模型预测到2050年的患病率。
2020年，全球有5.95亿人（95%不确定区间5.35 - 6.56亿）患有骨关节炎，占全球人口的7.6%（95%UI 6.8 - 8.4%），自1990年以来病例总数增加了132.2%（130.3 - 134.1%）。与2020年相比，预计到2050年，膝骨关节炎病例将增加74.9%（59.4 - 89.9%），手骨关节炎病例将增加48.6%（35.9 - 67.1%），髋骨关节炎病例将增加78.6%（57.7 - 105.3%），其他类型骨关节炎病例将增加95.1%（68.1 - 135.0%）。2020年全球骨关节炎总体YLDs的年龄标准化率为每10万人255.0 YLDs（119.7 - 557.2），比1990年（每10万人233.0 YLDs，109.3 - 510.8）增加了9.5%（8.6 - 10.1%）。对于70岁及以上的成年人，骨关节炎是YLDs的第七大原因。2020年所有世界区域的年龄标准化患病率均超过5.5%，从东南亚的每10万人5677.4（5029.8 - 6318.1）到高收入亚太地区的每10万人8632.7（7852.0 - 9469.1）。膝部是骨关节炎最常见的部位。高体重指数导致了20.4%（95%UI -1.7至36.6%）的骨关节炎。骨关节炎潜在的可改变风险因素，如预防娱乐性损伤和职业危害，尚未在全球疾病负担建模中进行探讨。
归因于骨关节炎的年龄标准化YLDs持续上升，由于人口增长和老龄化，以及骨关节炎尚无有效治愈方法，病例数将大幅增加。所有地区对骨关节炎患者护理的卫生系统需求，包括对髋部和膝部晚期骨关节炎非常有效的关节置换，都将上升，但对于无力承担的个人和国家来说可能无法实现，从而导致进一步的健康不平等。在预防人们进入晚期方面，还有很多可以而且应该做的事情。
比尔及梅琳达·盖茨基金会、骨与关节研究学会和全球肌肉骨骼健康联盟。
