Participation in Informal Caregiving Among People With Arthritis: Findings From a Canadian Longitudinal Study on Aging.

OBJECTIVE: Despite the joint pain and significant dysfunction that characterizes arthritis, many people with arthritis continue to carry out everyday duties and responsibilities. The objective of the present study was to describe participation in informal caregiving (unpaid assistance to someone with a health issue or limitation) among people with arthritis. METHODS: Analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative sample of people ages 45-85 years (n = 21,241), was performed. A questionnaire covering sociodemographic, health, and caregiving variables was completed by each study participant. Caregiving variables examined characteristics of the person who received the most care from the questionnaire respondent, as well as the types of caregiving (e.g., hands-on versus hands-off tasks) and amount of care provided (e.g., hours per week). RESULTS: There was no difference in the proportion of people with and without arthritis who provided informal care (46%). Individuals with arthritis reported worse health, but this did not affect the likelihood of providing care, nor the types or amount of care provided. Caregivers with and without arthritis were most likely to provide fewer than 7 hours per week of care, and the most common type of care was characterized as hands-off, particularly transportation assistance. Men were just as likely to provide care as women but were less likely to provide high intensity care or perform hands-on tasks. CONCLUSION: Despite reporting worse health on average, people with arthritis were just as likely as people without arthritis to provide informal care. The need to provide informal care among people with arthritis may impact their ability to engage in self-management activities for their arthritis.

The contribution of age and obesity to the number of painful joint sites in individuals reporting osteoarthritis: a population-based study.

OBJECTIVE: To investigate the association of OA risk factors with number of painful joint sites in a representative population sample. METHODS: Analysis of the 2009 Survey on Living with Chronic Diseases in Canada - Arthritis Component (n = 1614) for respondents reporting symptomatic OA. Variables: painful joints sites (hands, wrists, elbows, shoulders, hips, knees, ankles, feet, back, neck), joint symptom duration, sociodemographic characteristics, smoking, comorbidities and BMI. Zero-truncated negative binomial regressions were used to investigate the association between number of painful joint sites and the variables. Generalizability of findings was assessed by a similar analysis in a clinical hip/knee OA sample. RESULTS: The sample comprised 73% women and 56% were aged <65 years. The mean number of painful joint sites was 3.8: 84% reported pain at ≥2 sites, and 45% at ≥4 sites. Age, BMI, education and smoking were not associated with the number of joint sites. Significant associations were found with being female [rate ratio (RR) = 1.23, 95% CI 1.09, 1.39], having more comorbidities (RR = 1.11, 95% CI 1.07, 1.15) and longer symptom duration (RR = 1.16, 95% CI 1.09, 1.24), although the increase in joint sites with duration was small. Similar regression results were found with the clinical OA sample. CONCLUSION: The lack of an association of age and BMI (obesity) with number of painful joint sites in OA raises questions about the role of these risk factors and our understanding of OA as a multi-joint disease. Filling this knowledge gap is critical to making progress with defining OA phenotypes and identifying potential aetiological mechanisms.

An Update on Arthritis in Canada - National and Provincial Data Regarding the Past, Present, and Future.

OBJECTIVE: To provide updated arthritis estimates for Canada given a change in wording in the 2015 Canadian Community Health Survey (CCHS) arthritis question. METHODS: Prevalence data from the 2000 to 2016 CCHS were used to document trends in the prevalence of arthritis over time. Projections of arthritis prevalence were also calculated using data from CCHS 2015 in conjunction with Statistics Canada's published population projections. Data for 2015 were also used to provide summary data on the effect of arthritis. RESULTS: Between 2000 and 2014 there were some fluctuations in the prevalence of arthritis (age ≥ 15 yrs), with the range of prevalence varying between 15.4% and 17.6%. There was a significant increase in overall prevalence to over 20% with the 2015 and 2016 surveys (6 million Canadians), coinciding with a revised wording of the arthritis question. This increase was observed in all age and sex groups, except for men aged 85+. The overall characteristics of the 2015 arthritis population were similar to those in 2007/08. Using the updated 2015 CCHS arthritis data, projection estimates suggest the population prevalence of arthritis will increase to just over 24% by 2040, with the number of Canadians living with arthritis projected to increase by about 50% from 2015 to 2040. CONCLUSION: The revised question likely increased ascertainment of arthritis owing to inclusion of examples of arthritis diagnoses in the CCHS question and more explicit wording in the French version, resulting in a large increase in the estimated prevalence and numbers of people with arthritis in Canada.

Back Pain and Co-occurring Conditions: Findings From a Nationally Representative Sample.

STUDY DESIGN: Cross-sectional population-level health survey. OBJECTIVE: To describe the frequency of co-occurring conditions with back pain; to identify risk factors for back pain controlling for co-occurring conditions; and to examine the association between back pain and individual co-occurring conditions. SUMMARY OF BACKGROUND DATA: Back pain shares risk factors with a range of other conditions. Most studies have considered risk factors for back pain without taking into account the potential influence of co-occurring conditions. METHODS: Analysis of the 2013 Canadian Community Health Survey (n = 61,854, age ≥15 yr). Back pain status and co-occurring conditions were determined from questions about long-term health conditions diagnosed by a health profession. Multivariable log-Poisson regression analysis was used to assess the adjusted association of back pain with demographic and lifestyle characteristics and co-occurring conditions. RESULTS: The population prevalence of reported back pain was 19.3%. Most (71%) reported at least one co-occurring condition. Most frequently reported were arthritis (35%), high blood pressure (26%), migraine (18%), and mood disorders (14%). Following the addition of co-occurring condition count to the regression model, being female and being overweight/obese were no longer significantly associated with back pain, and the associations with ages 45 to 54 years and older, low-income, smoking, and being physical inactive were significantly attenuated. The highest prevalence ratio, 3.32 (95% confidence interval: 3.06-3.59), was for 3+ co-occurring conditions. In multivariable regression all but a few individual chronic conditions remained significant associated with back pain. CONCLUSION: Established risk factors for back pain may be largely a reflection of shared risk factors with co-occurring conditions. The high frequency of co-occurring conditions likely reflects diverse mechanisms related to heterogeneity of back pain. The extent of association of co-occurring conditions with back pain has implications for clinical management and need for further research to characterize subgroups. LEVEL OF EVIDENCE: 2.

Factors Associated with Adverse Events in Inpatient Elective Spine, Knee, and Hip Orthopaedic Surgery.

BACKGROUND: Orthopaedic procedures for degenerative musculoskeletal conditions (predominantly osteoarthritis and spinal stenosis) represent an increasing burden on the health-care system. These procedures are also associated with adverse event rates and related cost. The objective of this study was to identify risk factors for adverse events associated with orthopaedic surgeries as captured within a common clinical point-of-care system for documenting adverse events (Orthopaedic Surgical AdVerse Events Severity [OrthoSAVES] system). METHODS: In-hospital adverse events were recorded at the point of care over a 2-year period for inpatient elective knee, hip, and spine orthopaedic procedures for degenerative musculoskeletal conditions. Multivariable logistic regression was employed to investigate the association between various factors (age, sex, surgical site, body mass index, surgical risk classification, operative duration, length of stay, and medical comorbidities) and the occurrence of adverse events. RESULTS: The sample included 2,146 patients. The overall adverse event rate was 27% (571 of 2,146), and by surgical site, the rates were 29% (130 of 442) for spine; 27% (266 of 998) for knee; and 25% (175 of 706) for hip. The most common adverse events had a low severity grade, but spinal procedures demonstrated more adverse events with a severity grade of ≥3. Increasing age (odds ratio [OR] = 1.21, 95% confidence interval [CI] =1.05 to 1.41, per 15-year interval), male sex (OR = 1.43, 95% CI =1.16 to 1.77), increasing operative duration (OR = 1.13, 95% CI = 1.03 to 1.23, per 30-minute increase), length of stay (OR = 1.13, 95% CI = 1.10 to 1.17, per day), and undergoing revision surgery (OR = 2.23, 95% CI = 1.35 to 3.70) were independently associated with a greater likelihood of the occurrence of an adverse event. Spine surgery demonstrated decreased odds of an adverse event compared with knee surgery (OR = 0.38, 95% CI = 0.23 to 0.61) when operative duration and length of stay were taken into account. CONCLUSIONS: On the basis of our adjusted analysis, we found increasing age, male sex, revision surgery, length of stay, and increasing operative duration to be common independent risk factors for an adverse event across the population studied. The first 3 risk factors are not modifiable. The association between increasing operative duration and the risk of an adverse event across all anatomical regions and surgical procedures is a unique finding. However, modification of procedural efficiency is multifactorial and warrants further investigation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.