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. 2023 Aug 21;5(9):e508-e522.
doi: 10.1016/S2665-9913(23)00163-7. eCollection 2023 Sep.

Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Osteoarthritis Collaborators
Collaborators

Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021

GBD 2021 Osteoarthritis Collaborators. Lancet Rheumatol. .

Abstract

Background: Osteoarthritis is the most common form of arthritis in adults, characterised by chronic pain and loss of mobility. Osteoarthritis most frequently occurs after age 40 years and prevalence increases steeply with age. WHO has designated 2021-30 the decade of healthy ageing, which highlights the need to address diseases such as osteoarthritis, which strongly affect functional ability and quality of life. Osteoarthritis can coexist with, and negatively effect, other chronic conditions. Here we estimate the burden of hand, hip, knee, and other sites of osteoarthritis across geographies, age, sex, and time, with forecasts of prevalence to 2050.

Methods: In this systematic analysis for the Global Burden of Disease Study, osteoarthritis prevalence in 204 countries and territories from 1990 to 2020 was estimated using data from population-based surveys from 26 countries for knee osteoarthritis, 23 countries for hip osteoarthritis, 42 countries for hand osteoarthritis, and US insurance claims for all of the osteoarthritis sites, including the other types of osteoarthritis category. The reference case definition was symptomatic, radiographically confirmed osteoarthritis. Studies using alternative definitions from the reference case definition (for example self-reported osteoarthritis) were adjusted to reference using regression models. Osteoarthritis severity distribution was obtained from a pooled meta-analysis of sources using the Western Ontario and McMaster Universities Arthritis Index. Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLDs). Prevalence was forecast to 2050 using a mixed-effects model.

Findings: Globally, 595 million (95% uncertainty interval 535-656) people had osteoarthritis in 2020, equal to 7·6% (95% UI 6·8-8·4) of the global population, and an increase of 132·2% (130·3-134·1) in total cases since 1990. Compared with 2020, cases of osteoarthritis are projected to increase 74·9% (59·4-89·9) for knee, 48·6% (35·9-67·1) for hand, 78·6% (57·7-105·3) for hip, and 95·1% (68·1-135·0) for other types of osteoarthritis by 2050. The global age-standardised rate of YLDs for total osteoarthritis was 255·0 YLDs (119·7-557·2) per 100 000 in 2020, a 9·5% (8·6-10·1) increase from 1990 (233·0 YLDs per 100 000, 109·3-510·8). For adults aged 70 years and older, osteoarthritis was the seventh ranked cause of YLDs. Age-standardised prevalence in 2020 was more than 5·5% in all world regions, ranging from 5677·4 (5029·8-6318·1) per 100 000 in southeast Asia to 8632·7 (7852·0-9469·1) per 100 000 in high-income Asia Pacific. Knee was the most common site for osteoarthritis. High BMI contributed to 20·4% (95% UI -1·7 to 36·6) of osteoarthritis. Potentially modifiable risk factors for osteoarthritis such as recreational injury prevention and occupational hazards have not yet been explored in GBD modelling.

Interpretation: Age-standardised YLDs attributable to osteoarthritis are continuing to rise and will lead to substantial increases in case numbers because of population growth and ageing, and because there is no effective cure for osteoarthritis. The demand on health systems for care of patients with osteoarthritis, including joint replacements, which are highly effective for late stage osteoarthritis in hips and knees, will rise in all regions, but might be out of reach and lead to further health inequity for individuals and countries unable to afford them. Much more can and should be done to prevent people getting to that late stage.

Funding: Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health.

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Conflict of interest statement

BA reports an investigator-initiated trial grant from Rebecca Cooper Foundation and an investigator-initiated trial biomarkers assessment support grant from Nat Rem, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Nat Rem and IRACON, all outside the submitted work. AMB reports grants or contracts paid to his institution from the Bone and Joint Decade Foundation, AO Alliance, Canadian Memorial Chiropractic College, Australian Rheumatology Association, Pan-American League of Associations for Rheumatology, World Federation of Chiropractic, and Asia Pacific League of Associations for Rheumatology, consulting fees from WHO, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the American College of Rheumatology, and support for attending meetings and travel from WHO, all outside the submitted work. IF and AR report payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Avicenna Medical and Clinical Research Institute to provide critical feedback and comments on important intellectual content on Global Burden of Disease manuscripts before publication. A-FAM reports grants or contracts for MilkSafe, a novel pipeline to enrich formula milk using omics technologies, research cofinanced by the European Regional Development Fund of the EU and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call Research, Create, Innovate (project code T2EDK-02222), and from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860), payment for expert testimony from Fondazione Cariplo, Italy for having served as an external peer reviewer; leadership, or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Sytematic Reviews and Annals of Epidemiology as an Editorial Board Members, and with Translational Psychiatry as an Associate Editor, stock or stock options in a family winder, and other financial or non-financial support from BGI Group for serving as a scientific officer, all outside the submitted work. JAS reports consulting fees from Crealta-Horizon, Medisys, Fidia, PK Med, Two labs, Adept Field Solutions, Clinical Care options, Clearview Healthcare Partners, Putnam associates, Focus Forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point Communications, and the National Institutes of Health and the American College of Rheumatology, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the speaker's bureau of Simply Speaking, support for attending meetings and travel from the steering committee of OMERACT, participation on a Data Safety Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory Committee, leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as a steering committee member of the OMERACT, with the Veteran Affairs Rheumatology Field Advisory Committee as a Chair, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as an Editor, stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp., and Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals, all outside the submitted work. STS reports grants or contracts from the European Research Council paid to the university from the EU Horizon 2020 research innovation program (grant agreement 801790), the EU Horizon 2020 research innovation program paid to the hospital (grant agreement 945377), Region Zealand paid to the hospital as a program grant from Region Zealand (Exercise First), royalties from Munksgaard for book chapters and TrustMe-Ed for an online lecture, an honorarium from Nestlé Health Science for a webinar presentation on osteoarthritis, and other financial or non-financial interests as co-founder of GLA:D, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice, all outside the submitted work. HS reports grants or contracts paid to her institution from the Australian Government (Department of Health Grant), Medical Research Future Fund, Western Australian Government Department of Health, Bone and Joint Decade Foundation (Sweden), Curtin University (Australia), Institute for Bone and Joint Research (Australia), Canadian Memorial Chiropractic College (Canada), and support for attending meetings and travel from the Australian Pain Society, all outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Global prevalence of total osteoarthritis and each site of osteoarthritis in 2020 by sex and age Shaded area represents 95% uncertainty intervals.
Figure 2
Figure 2
Age-standardised prevalence per 100 000 of total osteoarthritis by country for male and female sexes combined in 2020
Figure 3
Figure 3
Contribution of different osteoarthritis sites to combined age-standardised prevalence, globally and by GBD region, 2020
Figure 4
Figure 4
Global cases of site-specific osteoarthritis forecasted to the year 2050 and decomposition analysis of relative contribution of change in prevalence rate, population growth, and population ageing to total percent change in age-restricted case number by region, 2020–50 Insets display global case numbers for each osteoarthritis site. Shading denotes 95% uncertainty intervals.
See this image and copyright information in PMC

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