Underrecording of osteoarthritis in United Kingdom primary care electronic health record data
Received 16 December 2017
Accepted for publication 24 April 2018
Published 12 September 2018 Volume 2018:10 Pages 1195—1201
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Irene Petersen
Dahai Yu, Kelvin P Jordan, George Peat
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Newcastle, UK
Purpose: Primary care electronic health records are increasingly used to estimate the occurrence of osteoarthritis (OA). We aimed to estimate the extent and trend over time of underrecording of severe OA patients in UK primary care electronic health records using first primary total hip and knee replacements (THR/TKR) – >90% of which are performed for OA – as the reference population.
Patients and methods: We identified patients with a first primary THR or TKR recorded in the UK Clinical Practice Research Datalink between 2000 and 2015. We then searched for a diagnostic/problem code for OA up to 10 years prior to THR/TKR using 3 definitions: “diagnosed OA (joint-specific),” “diagnosed OA (any joint),” “clinical OA” (diagnosed OA or relevant peripheral joint pain symptom code).
Results: Among 34,299 THR patients identified, 28.1%, 53.4%, and 74.4% had a prior record of diagnosed OA (hip), diagnosed OA (any), and clinical OA, respectively. Among 47,588 TKR patients, the corresponding figures were, 25.5% (diagnosed OA [knee]), 43.7%, and 74.8%. In the UK Clinical Practice Research Datalink, the proportion of patients with prior recorded OA decreased between 2000 and 2015.
Conclusion: An increasing trend of underrecording of OA or joint pain among patients with THR or TKR (severe OA patients) between 2000 and 2015 was identified. An underestimate health care demand could be derived based on consultation incidence and prevalence of OA from electronic health record data that relies on osteoarthritis diagnostic codes. Further studies are warranted to investigate the validity of OA or joint pain recorded in primary care settings, which might be used to correct the consultation incidence and prevalence of OA.
Keywords: joint pain, total knee replacement, total hip replacement, sensitivity
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