C Reyes1, M Garcia-Gil2, J M Elorza3, L Mendez-Boo4, E Hermosilla5, M K Javaid6, C Cooper7, A Diez-Perez8, N K Arden9, B Bolibar10, R Ramos11, D Prieto-Alhambra12. 1. Primary Health Care Department, Primary Health Care Center Eap Sardenya-Biomedical Resarch Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain. Electronic address: carlenreyesreyes@gmail.com. 2. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain. Electronic address: mgarcia@idiapjgol.info. 3. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain. Electronic address: jmelorza@idiapjgol.info. 4. Primary Care Services Information System, Catalan Health Institute (ICS), Barcelona, Spain. Electronic address: lmendezboo@gencat.cat. 5. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain. Electronic address: ehermosilla@idiapjgol.info. 6. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom. Electronic address: kassim.javaid@ndorms.ox.ac.uk. 7. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom. Electronic address: cc@mrc.soton.ac.uk. 8. Unitat de Recerca Musculo-esquelètica and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Barcelona, Spain. Electronic address: ADiez@parcdesalutmar.cat. 9. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Arthritis Research UK (ARUK), Center for Sports, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom. Electronic address: nigel.arden@ndorms.ox.ac.uk. 10. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain. Electronic address: bbolibar@idiapjgol.info. 11. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; Primary Health Care Department, Institut Català de la Salut, Barcelona, Spain. Electronic address: rramos.girona.ics@gencat.cat. 12. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom; Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Unitat de Recerca Musculo-esquelètica and RETICEF, IMIM Research Foundation, Parc de Salut Mar and Instituto de Salud Carlos III, Barcelona, Spain. Electronic address: Daniel.prietoalhambra@ndorms.ox.ac.uk.
Abstract
OBJECTIVE: To determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level. DESIGN: Retrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009-2012) were eligible. OUTCOMES: Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009-2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes. RESULTS: Compared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11-1.42) for hand, 1.23 (1.17-1.29) hip, and 1.51 (1.45-1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93-1.20), 1.04 (0.99-1.09), and 1.23 (1.19-1.28) respectively. CONCLUSIONS: Deprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities.
OBJECTIVE: To determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level. DESIGN: Retrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009-2012) were eligible. OUTCOMES: Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009-2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes. RESULTS: Compared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11-1.42) for hand, 1.23 (1.17-1.29) hip, and 1.51 (1.45-1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93-1.20), 1.04 (0.99-1.09), and 1.23 (1.19-1.28) respectively. CONCLUSIONS: Deprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities.
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