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Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: an analysis of UK electronic medical records

Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: an analysis of UK electronic medical records
Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: an analysis of UK electronic medical records
Objective: to provide descriptive data on rates of total hip replacement (THR) and total knee replacement (TKR) within a large RA cohort and describe variation in risk.

Methods: incident RA patients (1995 to 2014) were identified from the Clinical Practice Research Datalink (CPRD). First subsequent occurrence of THR and TKR were identified (analysed separately) and incidence rates calculated, stratified by sex, age, BMI, geographic region, and quintiles of the index of multiple deprivation (IMD) score.

Results: there were 27,607 RA patients included, with a total of 1,028 THRs (mean age at surgery: 68.4 years) and 1,366 TKRs (mean age at surgery: 67.6 years), at an overall incidence rate per 1,000 person-years (PYs) [95% CI] of 6.38 [6.00–6.78] and 8.57 [8.12–9.04], respectively. TKR incidence was similar by gender but THR rates were higher in females than males. Rates of TKR but not THR rose according to BMI. An increasing trend was observed in rates of both outcomes according to age (although not ≥75) but of decreasing rates according to socio-economic deprivation. There was some evidence for regional variation in TKR. The 10-year cumulative incidence was 5.2% [4.9, 5.6] and 7.0% [6.6, 7.4] for THR and TKR, respectively.

Conclusion: we provide generalizable estimates of THR and TKR incidence in the UK RA patient population and note variation across several key variables. Increased BMI was associated with a large increase in TKR but not THR incidence. Increased deprivation was associated with a downward trend in rates of THR and TKR.
0049-0172
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Edwards, Christopher
dcb27fec-75ea-4575-a844-3588bcf14106
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Judge, Andrew
53ccba98-13f0-4a06-b2ff-59a35616c990
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Edwards, Christopher
dcb27fec-75ea-4575-a844-3588bcf14106
Arden, Nigel
23af958d-835c-4d79-be54-4bbe4c68077f
Delmestri, Antonella
d6087fde-5a65-41de-9b5e-bcefc4379ceb
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Judge, Andrew
53ccba98-13f0-4a06-b2ff-59a35616c990

Hawley, Samuel, Edwards, Christopher, Arden, Nigel, Delmestri, Antonella, Cooper, Cyrus and Judge, Andrew (2019) Descriptive epidemiology of hip and knee replacement in rheumatoid arthritis: an analysis of UK electronic medical records. Seminars in Arthritis and Rheumatism. (doi:10.1016/j.semarthrit.2019.08.008).

Record type: Article

Abstract

Objective: to provide descriptive data on rates of total hip replacement (THR) and total knee replacement (TKR) within a large RA cohort and describe variation in risk.

Methods: incident RA patients (1995 to 2014) were identified from the Clinical Practice Research Datalink (CPRD). First subsequent occurrence of THR and TKR were identified (analysed separately) and incidence rates calculated, stratified by sex, age, BMI, geographic region, and quintiles of the index of multiple deprivation (IMD) score.

Results: there were 27,607 RA patients included, with a total of 1,028 THRs (mean age at surgery: 68.4 years) and 1,366 TKRs (mean age at surgery: 67.6 years), at an overall incidence rate per 1,000 person-years (PYs) [95% CI] of 6.38 [6.00–6.78] and 8.57 [8.12–9.04], respectively. TKR incidence was similar by gender but THR rates were higher in females than males. Rates of TKR but not THR rose according to BMI. An increasing trend was observed in rates of both outcomes according to age (although not ≥75) but of decreasing rates according to socio-economic deprivation. There was some evidence for regional variation in TKR. The 10-year cumulative incidence was 5.2% [4.9, 5.6] and 7.0% [6.6, 7.4] for THR and TKR, respectively.

Conclusion: we provide generalizable estimates of THR and TKR incidence in the UK RA patient population and note variation across several key variables. Increased BMI was associated with a large increase in TKR but not THR incidence. Increased deprivation was associated with a downward trend in rates of THR and TKR.

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MS_DescriptiveEpi_RA_THKR_v3.6_clean - Accepted Manuscript
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Accepted/In Press date: 1 August 2019
e-pub ahead of print date: 26 August 2019

Identifiers

Local EPrints ID: 434157
URI: http://eprints.soton.ac.uk/id/eprint/434157
ISSN: 0049-0172
PURE UUID: aa0ae1d6-cfb4-4ed9-a45b-1effe1763750
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 13 Sep 2019 16:30
Last modified: 26 Nov 2021 05:34

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Contributors

Author: Samuel Hawley
Author: Nigel Arden
Author: Antonella Delmestri
Author: Cyrus Cooper ORCID iD
Author: Andrew Judge

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