Incidence and risk factors of symptomatic knee osteoarthritis among the Chinese population: analysis from a nationwide longitudinal study

Abstract

Background: Knee osteoarthritis (OA) is a common disease condition associated with aging and a frequent cause of primary care consultations. Few longitudinal studies have been conducted to investigate the incidence of symptomatic knee osteoarthritis (OA) and to identify its risk factors among the Chinese population.

Methods: The China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal survey of persons aged ≥45 years. Symptomatic knee OA was diagnosed when both self-reported knee pain and self-reported physician-diagnosis arthritis existed. Using the national survey data collected from the CHARLS, we estimated the incidence of symptomatic knee OA, taking into account the complex survey design and response rate. We applied weighted logistic regression analysis to identify its risk factors.

Results: In the 4-year follow-up, the cumulative incidence of symptomatic knee OA among middle-aged and older Chinese adults was 8.5%; the incidence was higher among females (11.2%) than males (5.6%). Female (odds ratio (OR) 1.98 [95% confidence interval (CI) 1.65-2.37]), rural area (OR 1.32 [95% CI 1.08-1.60]), and West region (OR 2.33 [95% CI 1.89-2.87]) were associated with a higher risk of incident symptomatic knee OA. Physical activities (OR 0.47 [95% CI 0.29-0.76]) and high education level (OR 0.60 [95% CI 0.41-0.88]) was associated with a lower risk of incident symptomatic knee OA, while histories of heart disease (OR 1.40 [95% CI 1.07-1.82]), kidney disease (OR 1.80 [95% CI 1.35-2.39]), and digestive disease (OR 1.54 [95% CI 1.30-1.82]) were associated with a higher risk of incident symptomatic knee OA.

Conclusion: The cumulative incidence of symptomatic knee OA over 4 years was relatively high, and varied by province and region. Lack of physical activities was confirmed to be risk factors of incident symptomatic knee OA. The presence of heart disease, kidney disease, and digestive disease may be associated with a higher risk of incident symptomatic knee OA, further research need to confirm these findings.

Keywords: Chinese population; Incidence; Risk factor; Symptomatic knee OA.

Fig. 1

Flowchart showing the selection of the respondents who were included in the final analysis in this study

Fig. 2

The cumulative incidence of symptomatic knee OA in different provinces of China. Notes. The density maps were generated by DataMap for ArcGis 10.1, using the Chinese geographic map template. An appropriate license from ArcGis has been obtained