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Abstract Objective To explore temporal changes in incidence of major psychiatric disorders across sociodemographic subgroups in Sweden. Methods This population-based open cohort study included all individuals born during 1958–1994 and residing in Sweden at any time during 2004–2019. We identified psychiatric disorders registered in inpatient and outpatient specialist care. We calculated person-years from the inclusion until diagnosis of psychiatric disorder of interest, death, emigration or December 31, 2019, whichever occurred first. Combining sex (female, male), education (low, medium, high) and immigration status (first- or second-generation immigrant, native), we created a variable with 18 strata. Average annual percent changes (AAPCs) in age-standardized incidence rates (ASIRs) were estimated using Joinpoint regression. Results A total of 5,051,875 individuals aged 25–61 years were followed for ≈ 56–58 million person-years. First-generation immigrants generally had lower overall ASIRs than second-generation and natives with more pronounced differences among persons with low education and females. While ASIRs of autism spectrum and other pervasive developmental disorders (AAPC 11.8%, 95% CI: 9.5, 15.8), as well as attention deficit hyperactivity disorder and conduct disorders (18.8%, 16.6, 25.0) rose over time, other psychiatric disorders were stable or had decreasing temporal changes (AAPC ranged from 0% for substance use disorders to -5.7% for schizophrenia/acute and transient psychotic disorders). First-generation immigrants generally experienced more favourable changes (i.e. more decreases or less increases) in ASIRs and this was most evident among those with low education. Conclusions While incidence of psychiatric disorders in inpatient and outpatient specialist care generally declined during 2004–2019, there were important sociodemographic variations in temporal changes. Clinical trial number Not applicable.

Abstract Background Physical function constitutes a key component of outcome assessment for almost all osteoarthritis interventions. The aim was to compare physical function measured using a self-assessed performance-based test versus self-reported function using questionnaires among individuals with knee or hip osteoarthritis (OA) participating in a digital exercise and education therapy. Methods We analysed data from individuals aged 40 + years participating in the digital program. We extracted data on the self-assessed 30-second chair stand test (30s CST) and the function subscales of Knee injury/Hip disability and Osteoarthritis Outcome Score 12 (KOOS-12/HOOS-12) at enrolment and 3- (n = 10884) and 12-month (n = 3554) follow-ups. Participants completed Numeric Rating Scale (NRS) pain, EQ-5D-5L, and an external anchor: global rating of change scale. Correlations were assessed using the Spearman correlation coefficient, responsiveness using standardized response mean (SRM) and receiver operating characteristic (ROC) curves, and agreement using weighted percent of agreement and weighted Gwet’s agreement coefficient. Results Correlations were weak between the 30s CST and KOOS-12/HOOS-12 function (r 1 vs. SRM

Objective This study evaluated the effects of a 6-week osteoarthritis (OA) exercise and education intervention on metabolic health markers, including blood pressure (BP), glycated haemoglobin (HbA1c), high-density lipoprotein (HDL), cholesterol levels and weight in individuals with both OA and diabetes.Methods Data originated from the Swedish Osteoarthritis and Diabetes cohort, which is composed of the Swedish Osteoarthritis Register (SOAR) and National Diabetes Register. We included individuals diagnosed with OA and diabetes who underwent the intervention between January 2008 and December 2019, matched with controls with diabetes who did not based on birth year, sex, OA site (hip/knee) and OA diagnosis year. Outcomes included BP, HbA1c, HDL, total cholesterol levels and weight measured up to 3 years before and after SOAR enrolment. Statistical analyses used two-way fixed-effect models.Results The study included 4571 individuals with OA and diabetes (mean age: 69.5, SD: 7.8; women: 52.7%; knee OA: 71.2%) and 7925 controls. The intervention group showed a systolic BP decrease of approximately 1.0 mm Hg at 6 and 12 months compared with the control group. HDL levels increased by about 0.02 mmol/L at 12, 18 and 24 months. Weight decreased by approximately 0.5 kg at 6, 18 and 30 months. HbA1c levels increased by approximately 0.5 mmol/mol at 6 months. No essential differences were found in the total cholesterol levels.Conclusion An OA exercise and education intervention designed following OA clinical practice guidelines led to small and unlikely clinically relevant improvements in metabolic health markers in individuals with OA and diabetes.

BackgroundCardiovascular, respiratory, and musculoskeletal disease are among the leading causes of disability in middle-aged and older people. Health and lifestyle factors in youth have known associations with cardiovascular or respiratory disease in adulthood, but largely unknown associations with musculoskeletal disease.Methods and findingsWe included approximately 40,000 18-year-old Swedish males, who completed their conscription examination in 1969 to 1970, followed up until age of 60 years. Exposures of interest were physical health: body mass and height, blood pressure, pulse at rest, muscle strength, cardiorespiratory fitness, and hematocrit; self-reported lifestyle: smoking, alcohol, and drug use; self-reported health: overall, headache and gastrointestinal. We followed the participants through the Swedish National Patient Register for incidence of common musculoskeletal (osteoarthritis, back pain, shoulder lesions, joint pain, myalgia), cardiovascular (ischemic heart disease, atrial fibrillation), and respiratory diseases (asthma, chronic obstructive pulmonary disease, bronchitis). We analyzed the associations using general estimating equations Poisson regression with all exposures included in one model and adjusted for parental education and occupation. We found that higher body mass was associated with higher risk of musculoskeletal (risk ratio [RR] per 1 standard deviation [SD] 1.12 [95% confidence interval, CI 1.09, 1.16]), cardiovascular (RR 1.22 [95% CI 1.17, 1.27] per 1 SD) and respiratory diseases (RR 1.14 [95% CI 1.05, 1.23] per 1 SD). Notably, higher muscle strength and cardiorespiratory fitness were associated with higher risk of musculoskeletal disease (RRs 1.08 [95% CI 1.05, 1.11] and 1.06 [95% CI 1.01, 1.12] per 1 SD difference in exposure), while higher cardiorespiratory fitness was protective against both cardiovascular and respiratory diseases (RRs 0.91 [95% CI 0.85, 0.98] and 0.85 [95% CI 0.73, 0.97] per 1 SD exposure, respectively). We confirmed the adverse effects of smoking, with risk ratios when comparing 11+ cigarettes per day to non-smoking of 1.14 (95% CI 1.06, 1.22) for musculoskeletal, 1.58 (95% CI 1.44, 1.74) for cardiovascular, and 1.93 (95% CI 1.60, 2.32) for respiratory diseases. Self-reported headache (category "often" compared to "never") was associated with musculoskeletal diseases (RR 1.38 [95% CI 1.21, 1.58]) and cardiovascular diseases (RR 1.29 [95% CI 1.07, 1.56]), but had an inconclusive association with respiratory diseases (RR 1.13 [95% CI 0.79, 1.60]). No large consistent associations were found for other exposures. The most notable associations with specific musculoskeletal conditions were for cardiorespiratory fitness and osteoarthritis (RR 1.23 [95% CI 1.15, 1.32] per 1 SD) and for muscle strength and back pain (RR 1.18 [95% CI 1.12, 1.24] per 1 SD) or shoulder diseases (RR 1.27 [95% CI 1.19, 1.36] per 1 SD). The main limitations include lack of adjustment for genetic factors and environmental exposures from childhood, and that the register data were available for males only.ConclusionsWhile high body mass was a risk factor for all 3 studied groups of diseases, high cardiorespiratory fitness and high muscle strength in youth were associated with increased risk of musculoskeletal disease in middle age. We speculate that these associations are mediated by chronic overload or acute trauma.

Objective To investigate the associations between rheumatic and musculoskeletal diseases (RMDs) and incident dementia using population register‐based data. Methods This nested case‐control study was conducted based on a cohort of residents in the Skåne region, Sweden, aged 50 years and older in 2009 without doctor‐diagnosed dementia during 1998 to 2009 (n = 402,825). Individuals with a new main diagnosis of dementia during 2010 to 2019 were identified as incident patients with dementia (n = 22,131). Controls without diagnosed dementia were randomly matched 1:1 by sex, age, and Elixhauser comorbidity index using incidence density sampling. Separate conditional logistic regression analyses adjusted for confounders were fitted for the following RMDs, diagnosed at least 2 years before dementia diagnosis as exposure: gout, osteoarthritis, rheumatoid arthritis, spondyloarthropathies (SpA), and systemic connective tissue disorders. Subgroup analyses by dementia subtype, sex, age, comorbidity, and RMDs/dementia identification were conducted. Results Although gout (adjusted rate ratio 0.88; 95% confidence interval 0.79–0.97), osteoarthritis (0.92; 0.88–0.96), and systemic connective tissue disorders (0.91; 0.83–0.99) were associated with decreased risk of dementia, the associations for rheumatoid arthritis (1.05; 0.92–1.19) and SpA (1.17; 0.94–1.45) were inconclusive. The associations between RMDs and incident dementia were similar across sex, age, and comorbidity subgroups with a few exceptions (eg, an adjusted rate ratio of 0.99 [95% confidence interval 0.71–1.39] in males vs 1.31 [0.99–1.74] in female patients for SpA). Conclusion Persons with diagnosed RMDs seem to have comparable or slightly lower risks of developing dementia compared with those without known RMD.

Objective: To examine changes in prevalence and socioeconomic inequalities in knee and hip OA outcomes, in more specific surgery and non-surgery specialist care visits, from 2001 to 2011 in Sweden and to what extent sociodemographic factors can explain the changes. Design: We included all individuals aged ≥35 years resident in Sweden from 2001 to 2011. Individual-level data was retrieved from the Swedish Interdisciplinary Panel. Highest educational attainment was used as socioeconomic measure and the concentration index was used to assess relative and absolute educational inequalities. We used decomposition method to examine changes in prevalence and relative educational inequalities. Results: A total of 4,794,693 and 5,359,186 people were included for the years 2001 and 2011, respectively. The crude prevalence of surgery and specialist visits for knee and hip OA was 36–83% higher in 2011 than in 2001. The increase in hip OA outcomes was largely explained by changes in the sociodemographic composition of the population, whereas for knee OA outcomes, changes in the strength of the associations with sociodemographic factors appeared more important. All outcomes were concentrated among people with lower education in all study years. The relative inequalities declined over the study period, while the absolute inequalities increased for knee OA outcomes and remained stable for hip OA. Conclusion: Our findings show an increasing burden of all studied OA outcomes. Moreover, our findings suggest persistent educational inequalities with more surgeries and specialist visits among lower-educated individuals. Future research should incorporate additional variables to better understand and address these inequalities.

Objectives To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references.Methods Cohort study using prospectively collected healthcare data from the Skåne region, Sweden (~1.4 million residents). We extracted diagnoses for OA and 67 common chronic conditions. We included individuals aged 40+ years on 31 December 2007, with incident OA between 2008 and 2009. We selected references without OA, matched on birth year, sex, and year of death or moving outside the region. We employed group-based trajectory modelling to capture morbidity count trajectories from 1998 to 2019. Individuals without any comorbidity were included as a reference group but were not included in the model.Results We identified 9846 OA cases (mean age: 65.9 (SD 11.7), female: 58%) and 9846 matched references. Among both cases and references, 1296 individuals did not develop chronic conditions (no-chronic-condition class). We identified four classes. At the study outset, all classes exhibited a low average number of chronic conditions (≤1). Class 1 had the slowest progression towards multimorbidity, which increased progressively in each class. Class 1 had the lowest count of chronic conditions at the end of the follow-up (mean: 2.9 (SD 1.7)), while class 4 had the highest (9.6 (2.6)). The presence of OA was associated with a 1.29 (1.12, 1.48) adjusted relative risk of belonging to class 1 up to 2.45 (2.12, 2.83) for class 4.Conclusions Our findings suggest that individuals with OA face an almost threefold higher risk of developing severe multimorbidity.

Abstract Background Public health policies and healthcare quality play a pivotal role on the health outcome level and disparities across sociodemographic groups. However, there is little evidence on their role on disparities in life expectancy (LE) and life disparity (LD) in low and middle income countries. The present study aimed to assess the contributions of avoidable mortality, as a measure of inter-sectoral public health policies and healthcare quality, into the sex gap in LE (SGLE) and LD (SGLD) in Iran. Methods Latest available data of death causes, according to the ICD codes, for Iran was obtained from the WHO mortality database for the period 2015–2016. An upper age limit of 75 years was applied to define avoidable causes of death. LD was measured as the average years of life lost at birth. The SGLE and SGLD (both females minus males) were decomposed by age and cause of death using a continuous-change model. Results Females, on average, outlived males for 3.8 years (80.0 vs. 76.2 years) with 1.9 lower life years lost (12.6 vs. 14.4 years). Avoidable causes accounted for 2.5 (67%) and 1.5 (79%) years of the SGLE and SGLD, respectively. Among avoidable causes, injury-related deaths followed by ischaemic heart disease had the greatest contributions to both SGLE and SGLD. Across age groups, the age groups 55–59 and 60–64 accounted for the greatest contributions of avoidable causes to SGLE (0.3 years each), while age groups 20–24 and 55–59 had the greatest contributions to SGLD (0.15 years each). Lower mortality rates for females than males in age groups 50–74 years accounted for about half of the SGLE, while age groups 20–29 and 50–64 years accounted for around half of SGLD. Conclusion More than two third of the SGLE and SGLD in Iran were attributed to the avoidable mortality, particularly preventable causes. Our results suggest the need for public health policies targeting injuries in young males as well as lifestyle risk factors including smoking in middle aged males in Iran.

Objective: To explore sex and age differences in Patient-Reported Outcomes Measures (PROMs) and adherence to digital osteoarthritis (OA) self-management intervention. Methods: A register-based study with data from an OA digital self-management intervention. PROMs and adherence were collected at baseline and/or 3 ​month follow-up: ‘pain intensity’ in hip/knee (best/worst: 0–10), ‘activity impairments' (best/worst: 0–10), ‘overall health’ perception (worst/best: 0–10), ‘physical function’ (30-s chair stand test), ‘health-related quality of life’ (EQ-5D-5L index score; worst/best: 0.243–0.976), the subscales and total scores of the Knee Injury/Hip Disability and Osteoarthritis Outcome Score (KOOS/HOOS-12; worst/best: 0–100), ‘fear of movement’ (yes/no), ‘walking difficulties' (yes/no), ‘programme adherence’ (0–100 ​% and ≥80 ​% [yes/no]), ‘patient acceptable symptom state’ (PASS; yes/no), and ‘treatment failure’ (those who answered no to PASS question and thought the treatment failed [yes/no]). We used linear/logistic regression to calculate mean/risk differences in the PROMs and adherence levels among sex and age groups at 3-month follow-up. We employed entropy balancing to explore the contributions of baseline characteristics and different covariates to the sex/age differences. Results: We included 14,610 participants (mean (SD) age: 64.1 (9.1), 75.5 ​% females). Females generally reported better outcomes than males. Participants aged ≥70 had greater activity impairments, lower KOOS/HOOS-pain/function scores, more walking difficulties, less fear of movement and higher adherence than those

Abstract Objective To investigate the trajectories of work and activity impairments among people participating in a digital self-management program for osteoarthritis (OA). Methods We conducted an observational longitudinal study using data for baseline, 3, 6, 9 and 12 months follow ups from people participating in a digital OA treatment between June 2018 and September 2021. The Work Productivity and Activity Impairment–Osteoarthritis (WPAI–OA) questionnaire was used to measure work and activity impairments. We applied linear mixed models and group-based trajectory modelling (GBTM) to assess the trajectories of work and activity impairments and their variability. Dominance analysis was performed to explore the relative importance of baseline characteristics in predicting the trajectory subgroup membership. Results A total of 14,676 participants with mean (± standard deviation) age 64.0 (± 9.1) years and 75.5% females were included. The adjusted mean improvements in work impairment from baseline were 5.8% (95% CI 5.3, 6.4) to 6.1% (95% CI 5.5, 6.8). The corresponding figures for activity impairment were 9.4% (95% CI 9.0, 9.7) to 11.3% (95% CI 10.8, 11.8). GBTM identified five (low baseline–declining, moderate baseline–declining, high baseline–declining, very high baseline–substantially declining, and very high baseline–persistent) and three (low baseline–declining, mild baseline–declining, high baseline–declining) subgroups with distinct trajectories of activity and work impairments. Dominance analysis showed that baseline pain was the most important predictor of membership in trajectory subgroups. Conclusion While participation in a digital self-management program for OA was, on average, associated with improvements in work and activity impairments, there were substantial variations among the participants. Baseline pain may provide useful insights to predict trajectories of work and activity impairments.

Abstract Objective Treatment adherence is suggested to be associated with greater improvement in patient outcomes. Despite the growing use of digital therapeutics in osteoarthritis management, there is limited evidence of person-level factors influencing adherence to these interventions in real-world settings. We aimed to determine the relative importance of factors influencing adherence to a digital self-management intervention for hip/knee osteoarthritis. Methods We obtained data from people participating in a digital OA treatment, known as Joint Academy, between January 2019 and September 2021. We collected data on the participants’ adherence, defined as the percentage of completed activities (exercises, lessons, and quizzes), at 3 (n = 14,610)- and 12-month (n = 2682) follow-up. We used dominance and relative weight analyses to assess the relative importance of sociodemographic (age, sex, place of residence, education, year of enrolment), lifestyle (body mass index, physical activity), general health (comorbidity, overall health, activity impairment, anxiety/depression), and osteoarthritis-related (index joint, fear of moving, walking difficulties, pain, physical function, wish for surgery, Patient Acceptable Symptom State) factors, measured at baseline, in explaining variations in adherence. We used bootstrap (1000 replications) to compute 95% confidence intervals. Results Mean (SD) adherences at 3 and 12 months were 86.3% (16.1) and 84.1% (16.7), with 75.1% and 70.4% of participants reporting an adherence ≥ 80%, respectively. The predictors included in the study explained only 5.6% (95% CI 5.1, 6.6) and 8.1% (7.3, 11.6) of variations in 3- and 12-month adherences, respectively. Sociodemographic factors were the most important predictors explaining more variations than other factors altogether. Among single factors, age with a nonlinear relationship with adherence, was the most important predictor explaining 2.3% (95% CI 1.9, 2.8) and 3.7% (2.4, 5.3) of variations in 3- and 12-month adherences, respectively. Conclusion Person-level factors could only modestly explain the variations in adherence with sociodemographic characteristics, mainly age, accounting for the greatest portion of this explained variance.

Abstract Background Injury deaths constitute a major avoidable cause of death affecting life expectancy to a different degree in men and women. This study quantified the contributions of injury deaths to the gender gap in life expectancy (GGLE) and life disparity (GGLD) in nine Eastern Mediterranean Region (EMR) countries. Methods We retrieved annual data on age-sex specific causes of death from the World Health Organization mortality database for EMR countries with at least 2-year consecutive data during 2010–2019. The injury-related deaths were categorized into five groups: transport accidents, other accidental injuries, intentional self-harm, assault and events of undetermined intent. Considering women as the reference, the GGLE and GGLD were decomposed by age and causes of death, using a continuous-change model. Results The largest and smallest GGLE were observed in Kuwait (5.2 years) and Qatar (− 1.2 years), respectively. Qatar (− 2.2 years) and Oman (0.2 years) had the highest and lowest GGLD. The highest contributions of injury deaths to the GGLE/GGLD were seen in Libya (1.8/− 1.2 years), followed by Iran (1.2/− 0.8 years). Among injury causes, transport accidents were the leading cause of GGLE in all countries but Libya and Morocco, with Iran having the greatest contributions (0.6 years). Injury deaths in men aged 15–29 years accounted for 33% [41%] (Kuwait) to 55% [65%] (Oman) of total GGLE [GGLD] attributable to injury deaths. Conclusions High injury deaths, particularly transport accidents, among young men contributed substantially to the GGLE and GGLD across nine EMR countries in this study. This highlights the need for implementing preventing policies to reduce the burden of injury deaths specifically in young men.

Abstract Background Previous studies have reported an inverse association between educational attainment and different osteoarthritis (OA) outcomes. However, none of the previous studies have accounted for potential confounding by early-life environment and genetics. Thus, we aimed to examine the association between educational attainment and knee and hip OA surgery using twin data. Methods From the Swedish Twin Registry (STR), we identified dizygotic (DZ) and monozygotic (MZ) twins. All twins in the STR aged 35 to 64 years were followed from January the 1st 1987 or the date they turned 35 years until OA surgery, relocation outside Sweden, death or the end of 2016 (18,784 DZ and 8,657 MZ complete twin pairs). Associations between educational attainment and knee and hip OA surgery were estimated in models matched on twin pairs, using Weibull within-between (WB) shared frailty model. Results For knee OA surgery, the analysis matched on MZ twins yielded a within-estimate hazard ratio (HR) per 3 years of education, of 1.06 (95% CI: 0.81, 1.32), suggesting no association between the outcome and the individual´s education. Rather, there seemed to be a so called familial effect of education, with a between-pair estimate of HR = 0.71 (95% CI: 0.41, 1.01). For hip OA surgery, the within- and between-pair estimates for MZ twins were 0.92 (95% CI: 0.69, 1.14) and 1.15 (95% CI: 0.87, 1.42), respectively. Conclusions Our results suggest that the inverse associations between education and knee/hip OA surgery observed in cohort studies are potentially confounded by unobserved familial factors like genetics and/or early life exposures.

The SARS-CoV-2 Omicron variant is associated with less severe disease but less is known about variant-specific risk of long-term complaints. Monitoring 1.3 million individuals from Norway for post-acute COVID-19 complaints up to 126 days shows that the burden is similar for Omicron and Delta for most complaints except for musculoskeletal pain.

Objective: Establish proportions of patients reporting important improvement, acceptable symptoms and treatment failure and define interpretation threshold values for pain, patient-reported function and quality-of-life after participating in digital first-line treatment including education and exercise for hip and knee osteoarthritis (OA). Methods: Observational study. Responses to the pain Numeric Rating Scale (NRS, 0–10 best to worst), Knee injury and Osteoarthritis Outcome Score 12 (KOOS-12) and Hip disability and Osteoarthritis Outcome Score 12 (HOOS-12, both 0–100 worst to best) were obtained for 4383 (2987) and 2041 (1264) participants with knee (hip) OA at 3 and 12 months post intervention. Threshold values for Minimal Important Change (MIC), Patient Acceptable Symptom State (PASS) and Treatment Failure (TF) were estimated using anchor-based predictive modeling. Results: 70–85% reported an important improvement in pain, function and quality of life after 3 and 12 months follow-up. 42% (3 months) and 51% (12 months) considered their current state as satisfactory, whereas 2–4% considered treatment failed. MIC values were −1 (NRS) and 0–4 (KOOS/HOOS-12) across follow-ups and joint affected. PASS threshold value for NRS was 3, and 53–73 for the KOOS/HOOS-12 subscales Corresponding values for TF were 5 (NRS) and 34–55 (KOOS/HOOS-12). Patients with more severe pain at baseline had higher MIC scores and accepted poorer outcomes at follow-ups. Conclusion: Threshold estimates aid in the interpretation of outcomes after first-line OA interventions assessed with NRS Pain and KOOS/HOOS-12. Baseline pain severity is important to consider when interpreting threshold values after first-line interventions in these patients.

Abstract Background Healthcare system and intersectoral public health policies play a crucial role in improving population health and reducing health inequalities. This study aimed to quantify their impact, operationalized as avoidable deaths, on the gap in life expectancy (LE) and lifespan inequality (LI) between Iran and three neighbour countries viz., Turkey, Qatar, and Kuwait in 2015–2016. Methods Annual data on population and causes of deaths by age and sex for Iran and three neighbour countries were obtained from the World Health Organization mortality database for the period 2015–2016. A recently developed list by the OECD/Eurostat was used to identify avoidable causes of death (with an upper age limit of 75). The cross-country gaps in LE and LI (measured by standard deviation) were decomposed by age and cause of death using a continuous-change model. Results Iranian males and females had the second lowest and lowest LE, respectively, compared with their counterparts in the neighbour countries. On the other hand, the highest LIs in both sexes (by 2.3 to 4.5 years in males and 1.1 to 3.3 years in females) were observed in Iran. Avoidable causes contributed substantially to the LE and LI gap in both sexes with injuries and maternal/infant mortality represented the greatest contributions to the disadvantages in Iranian males and females, respectively. Conclusions Higher mortality rates in young Iranians led to a double burden of inequality –shorter LE and greater uncertainty at timing of death. Strengthening intersectoral public health policies and healthcare quality targeted at averting premature deaths, especially from injuries among younger people, can mitigate this double burden.

Objective: To investigate the associations between incipient dementia (ID) and hospitalization for ambulatory care sensitive conditions (ACSCs) among people with osteoarthritis (OA) of the peripheral joints. Methods: Among individuals aged 51–99 years residing in Skåne, Sweden, in 2009, we identified those with a doctor-diagnosed OA and no dementia during 1998–2009 (n ​= ​57,733). Treating ID as a time-varying exposure, we followed people from January 1, 2010 or their 60th birthday (whichever occurred last) until hospitalization for ACSCs, death, 100th birthday, relocation outside Skåne, or December 31, 2019 (whichever occurred first). Using age as time scale, we applied flexible parametric survival models, adjusted for confounders, to assess the associations between ID and hospitalization for ACSCs. Results: There were 58 and 33 hospitalizations for ACSCs per 1000 person-years among OA people with and without ID, respectively. The association between ID and hospitalization for any ACSCs was age-dependent with higher risk in ages

Objective: To investigate whether the first wave of the COVID-19 pandemic impacted healthcare consultations (HCC) and hospitalization among people with and without osteoarthritis (OA). Methods: Using register data, we included individuals aged ≥35 years residing in Skåne region, Sweden, during 2009–2019 with (n ​= ​123,523) and without (n ​= ​552,412) a diagnosis of OA during January 1, 2009–December 31, 2019. We collected bi-weekly individual data on HCC/hospitalization between January and May for years 2017–2020. Treating the year 2020 as intervention and 2017–2019 as control as well as dividing data to pre– (January–February) and post–pandemic (March–May), we applied event study design to measure the dynamic effects of the COVID-19 pandemic on HCC/hospitalization. We used fixed-effect Poisson regressions for estimation and subgroup analyses by sex, age, and comorbidity were conducted among OA patients. Results: The impact of the pandemic on healthcare use was evident from mid-March 2020 (34–45%/12–25% reductions in in-person HCC/hospitalization) among people with OA relative to 2017–2019. Smaller reductions were seen in those without OA with 25–34%/8–16% reductions in in-person HCC/hospitalization. On contrary, there were increases in remote HCC following the pandemic (5–25% and 11–31% in people with and without OA, respectively). Among persons with OA, there were variations in the pandemic's effects by sex, age and comorbidity. Conclusion: Despite no lockdown in Sweden there were substantial reductions in in-person healthcare use during the first wave of COVID-19 pandemic with greater reductions among people with than without OA.

Aim: To study the risk of receiving a new (incident) osteoarthritis (OA) diagnosis in different joint sites based on conditions diagnosed in the 20 years prior the OA diagnosis. Methods: We used register data for the entire population of the Skåne region (Sweden) to perform a nested case-control study. The outcome was newly diagnosed (incident) OA in peripheral joints, i.e. knee (ICD-10 code M17), hip (M16) and other joints (M15, M18, M19), diagnosed in 2018 or 2019 in persons aged 45+ years with 20 years of register coverage. For each OA case, we sampled 1 control matched on age (1-year strata), sex and residential area in the year of index date using incidence density sampling. The exposures of interest comprised 50 comorbidities. We used adjusted conditional logistic regression for analysis. Results: Between January 1st, 2018 and December 31st, 2019, we identified 7 201, 2 895, and 7863 persons, respectively, with newly diagnosed knee, hip and other OA. Hypertension, back pain, gout, allergy, depression, anxiety and migraine were all associated with increased risk of knee OA diagnosis, while only gastroesophageal reflux disease and back pain were associated with newly diagnosed hip OA. Interestingly, many of the analysed conditions were associated with increased risk of OA diagnosis in other peripheral joints, including diagnosed generalised OA. Conclusions: The risk of being diagnosed with OA increases with the presence of multimorbidity earlier in life, but the associations seem to differ between weight-bearing and non-weight-bearing joints.

Objectives: To investigate the role of osteoarthritis (OA) in the incidence of musculoskeletal, metabolic, cardiovascular, digestive, neuro-psychological, kidney and other comorbidities/adverse events after (i) incident non-steroidal anti-inflammatory drug (NSAID) initiation and (ii) NSAID discontinuation. Methods: We used register data for the population of Skåne, Sweden. For (i), we analysed the association between starting NSAIDs and the risk of incident outcome events in the 6 years following NSAID dispensation among people with prevalent OA vs no OA. For (ii) we studied the effect of discontinuing NSAIDs among people with and without OA up to 120 days. We used flexible parametric models to estimate adjusted differences in cumulative incidence with NSAIDs as time-varying exposure in the presence of non-proportional hazards. Results: For (i) we included between 243,832 and 409,749 persons. In the whole cohort, over the 6 years of follow-up, NSAID initiation was associated with a 3% (metabolic) to 16% (musculoskeletal) higher cumulative incidence of outcomes compared to non-users. The difference between those initiating NSAIDs vs non-users was similar in those with and without OA for most outcomes, but in those with OA the increase was lower for neuro-psychological (95%CI: 3.7%–4.6% vs 7.1%–7.9%) and musculoskeletal comorbidities (12%–14.5% vs 16.2%–17.2%).In (ii), we found no interaction between OA and NSAID discontinuation. NSAID discontinuation was associated with decreased risks for most of the outcomes, from −1.3% for musculoskeletal to −0.4% for cardiovascular comorbidities. Conclusions: OA appears to have little influence on the increased risk of comorbidities observed after NSAID initiation or decrease after discontinuation.

BackgroundExercise and education is recommended as first-line treatment by evidence-based, international guidelines for low back pain (LBP). Despite consensus regarding the treatment, there is a gap between guidelines and what is offered to patients. Digital LBP treatments are an emerging way of delivering first-line treatment. ObjectiveThe aim of this study is to evaluate outcomes after participation in a 3-month digitally delivered treatment program for individuals with subacute or chronic LBP. MethodsWe analyzed data from 2593 consecutively recruited participants in a digitally delivered treatment program, available via the national health care system in Sweden. The program consists of video-instructed and progressive adaptable exercises, education through text lessons, and a chat and video function connecting participants with a personal physiotherapist. The primary outcome was mean change and proportion reaching a minimal clinically important change (MCIC) for LBP (2 points or 30% decrease) assessed with the numerical rating scale (average pain during the past week, discrete boxes, 0-10, best to worst). Secondary outcomes were mean change and proportion reaching MCIC (10 points or 30%) in disability, assessed with the Oswestry Disability Index (ODI; 0-100, best to worst) and a question on patient acceptable symptom state (PASS). ResultsThe mean participant age was 63 years, 73.85% (1915/2593) were female, 54.72% (1419/2593) had higher education, 50.56% (1311/2593) were retired, and the mean BMI was 26.5 kg/m2. Participants completed on average 84% of the prescribed exercises and lessons, with an adherence of ≥80% in 69.26% (1796/2593) and ≥90% in 50.13% (1300/2593) of the participants. Mean reduction in pain from baseline to 3 months was 1.7 (95% CI –1.8 to –1.6), corresponding to a 35% relative change. MCIC was reached by 58.50% (1517/2593) of participants. ODI decreased 4 points (95% CI –4.5 to –3.7), and 36.48% (946/2593) reached an MCIC. A change from no to yes in PASS was seen in 30.35% (787/2593) of participants. Multivariable analysis showed positive associations between reaching an MCIC in pain and high baseline pain (odds ratio [OR] 1.9, 95% CI 1.6-2.1), adherence (OR 1.5, 95% CI 1.3-1.8), and motivation (OR 1.2, 95% CI 1.0-1.5), while we found negative associations for wish for surgery (OR 0.6, 95% CI 0.5-0.9) and pain in other joints (OR 0.9, 95% CI 0.7-0.9). We found no associations between sociodemographic characteristics and pain reduction. ConclusionsParticipants in this digitally delivered treatment for LBP had reduced pain at 3-month follow-up, and 58.50% (1517/2593) reported an MCIC in pain. Our findings suggest that digital treatment programs can reduce pain at clinically important levels for people with high adherence to treatment but that those with such severe LBP problems that they wish to undergo surgery may benefit from additional support. Trial RegistrationClinicalTrials.gov NCT05226156; https://clinicaltrials.gov/ct2/show/NCT05226156