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      The number of persons with symptomatic knee osteoarthritis in the United States: Impact of race/ethnicity, age, sex, and obesity

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          Abstract

          Objective

          The prevalence of symptomatic knee osteoarthritis (OA) has been increasing over the past several decades in the United States concurrent with an aging population and the growing obesity epidemic. We quantify the impact of these factors on the number of persons with symptomatic knee OA in the first decades of 21st century.

          Methods

          We calculated prevalence of clinically diagnosed symptomatic knee OA from the National Health Interview Survey 2007–08 and derived the proportion with advanced disease (Kellgren-Lawrence grades 3–4) using the Osteoarthritis Policy Model, a validated simulation model of knee OA. Incorporating contemporary obesity rates and population estimates, we calculated the number of persons living with symptomatic knee OA.

          Results

          We estimate that about fourteen million persons had symptomatic knee OA, with advanced OA comprising over half of those cases. This includes over three million African American, Hispanic, and other racial/ethnic minorities. Adults under 45 years of age represented nearly two million cases of symptomatic knee OA and individuals between 45 and 65 years of age six million more.

          Conclusion

          Over half of all persons with symptomatic knee OA are younger than 65 years of age. As many of these younger persons will live for three decades or more, there is substantially more time for greater disability to occur and policymakers should anticipate healthcare utilization for knee OA to increase further in upcoming decades. These data emphasize the need for the deployment of innovative prevention and treatment strategies for knee OA, especially among younger persons.

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          Most cited references 29

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          The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review.

          To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints. A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through meta-analysis and between-study heterogeneity was quantified. Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence meta-analysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn't allow us to make any comparison according to joint site or OA definition. Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
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            Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study.

            To investigate the relationship between body mass index (BMI) and the incidence and progression of radiological knee as well as of radiological hip osteoarthritis. Cohort study. Population based. 3585 people aged > or =55 years were selected from the Rotterdam Study, on the basis of the availability of radiographs of baseline and follow-up. Incidence of knee or hip osteoarthritis was defined as minimally grade 2 at follow-up and grade 0 or 1 at baseline. The progression of osteoarthritis was defined as a decrease in joint space width. x Rays of the knee and hip at baseline and follow-up (mean follow-up of 6.6 years) were evaluated. BMI was measured at baseline. A high BMI (>27 kg/m(2)) at baseline was associated with incident knee osteoarthritis (odds ratio (OR) 3.3), but not with incident hip osteoarthritis. A high BMI was also associated with progression of knee osteoarthritis (OR 3.2). For the hip, a significant association between progression of osteoarthritis and BMI was not found. On the basis of these results, we conclude that BMI is associated with the incidence and progression of knee osteoarthritis. Furthermore, it seems that BMI is not associated with the incidence and progression of hip osteoarthritis.
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              The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic.

              Total knee replacement utilization in the United States more than doubled from 1999 to 2008. Although the reasons for this increase have not been examined rigorously, some have attributed the increase to population growth and the obesity epidemic. Our goal was to investigate whether the rapid increase in total knee replacement use over the past decade can be sufficiently attributed to changes in these two factors. We used data from the Nationwide Inpatient Sample to estimate changes in total knee replacement utilization rates from 1999 to 2008, stratified by age (eighteen to forty-four years, forty-five to sixty-four years, and sixty-five years or older). We obtained data on obesity prevalence and U.S. population growth from federal sources. We compared the rate of change in total knee replacement utilization with the rates of population growth and change in obesity prevalence from 1999 to 2008. In 2008, 615,050 total knee replacements were performed in the United States adult population, 134% more than in 1999. During the same time period, the overall population size increased by 11%. While the population of forty-five to sixty-four-year-olds grew by 29%, the number of total knee replacements in this age group more than tripled. The number of obese and non-obese individuals in the United States increased by 23% and 4%, respectively. Assuming unchanged indications for total knee replacement among obese and non-obese individuals with knee osteoarthritis over the last decade, these changes fail to account for the 134% growth in total knee replacement use. Population growth and obesity cannot fully explain the rapid expansion of total knee replacements in the last decade, suggesting that other factors must also be involved. The disproportionate increase in total knee replacements among younger patients may be a result of a growing number of knee injuries and expanding indications for the procedure.
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                Author and article information

                Journal
                101518086
                37048
                Arthritis Care Res (Hoboken)
                Arthritis Care Res (Hoboken)
                Arthritis care & research
                2151-464X
                2151-4658
                26 August 2016
                03 November 2016
                December 2016
                01 December 2017
                : 68
                : 12
                : 1743-1750
                Affiliations
                [1 ] Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
                [2 ] Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, United States
                [3 ] Harvard Medical School, Boston, Massachusetts, United States
                [4 ] Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States
                [5 ] Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, United States
                [6 ] Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States
                [7 ] Rosalind Russell / Ephraim P. Engleman Rheumatology Research Center, Division of Rheumatology, University of California, San Francisco, San Francisco, California, United States
                [8 ] Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
                [9 ] Department of Rheumatology, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
                [10 ] J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States
                [11 ] Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
                [12 ] Section on Rheumatology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
                [13 ] Center for Biomolecular Imaging, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
                [14 ] Section of Rheumatology, Yale School of Medicine, New Haven, Connecticut, United States
                [15 ] Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut, United States
                [16 ] Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States
                [17 ] Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States
                Author notes
                Correspondence: Elena Losina, PhD, Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BC 4-016, Boston, MA 02115, elosina@ 123456partners.org , Phone: (617) 732-5338; Fax: (617) 525-7900
                Article
                PMC5319385 PMC5319385 5319385 nihpa775448
                10.1002/acr.22897
                5319385
                27014966
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