Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models

Abstract

Objective: To establish the frequency of concordant, discordant, and clinically dominant comorbidities among Medicare beneficiaries with knee osteoarthritis (KOA) and to identify common concordant condition subgroups.

Participants and methods: We used a 5% representative sample of Medicare claims data to identify beneficiaries who received a diagnosis of KOA between January 1, 2012, and September 30, 2015, and matched control group without an osteoarthritis (OA) diagnosis. Frequency of 34 comorbid conditions was categorized as concordant, discordant, or clinically dominant among those with KOA and a matched sample without OA. Comorbid condition phenotypes were characterized by concordant conditions and derived using latent class analysis among those with KOA.

Results: The study sample included 203,361 beneficiaries with KOA and 203,361 non-OA controls. The largest difference in frequency between the two cohorts was for co-occurring musculoskeletal conditions (23.7% absolute difference), chronic pain syndromes (6.5%), and rheumatic diseases (4.5%), all with a higher frequency among those with knee OA. Phenotypes were identified as low comorbidity (53% of cohort with classification), hypothyroid/osteoporosis (27%), vascular disease (10%), and high medical and psychological comorbidity (10%).

Conclusions: Approximately 47% of Medicare beneficiaries with KOA in this sample had a phenotype characterized by one or more concordant conditions, suggesting that existing clinical pathways that rely on single or dominant providers might be insufficient for a large proportion of older adults with KOA. These findings could guide development of integrated KOA-comorbidity care pathways that are responsive to emerging priorities for personalized, value-based health care.

Keywords: APT, Assistance with Pain Treatment; CMS, Centers for Medicare and Medicaid Services; FFS, Medicare Fee-for-Service; KOA, knee osteoarthritis; LCA, latent class analysis; OA, osteoarthritis; SNF, skilled nursing facility.

Figure 1

Osteoarthritis comorbidity conceptual model. CHF = congestive heart failure; COPD = chronic obstructive pulmonary disease; CVD = cardiovascular disease; GI = gastrointestinal; HIV/AIDS = human immunodeficiency virus/acquired immunodeficiency syndrome; OA = osteoarthritis; PVD = peripheral vascular disease.

Figure 2

Probability of each comorbidity given latent class: 4-class model.