Temporal Trends and Demographic Evaluation of Hospitalizations Due to Osteoarthritis

Abstract

Objective To describe the temporal trends of osteoathritis (OA) according to hospital discharges considering anatomical location, distribution by gender, age, more frequent conditions, and geographic location in Chile between 2012 and 2018.

Methodology A retrospective, descriptive and population study which analyzed the public databases of the Department of Health Statistics and Information (Departamento de Estadísticas e Información en Salud, DEIS, in Spanish) of the Ministry of Health of Chile, in particular the records with codes M15 through M19. Rates per 100 thousand hospital discharges were calculated, as well as the percentage of OA according to the categories analyzed.

Results A total of 11,622,605 hospital discharges were found between 2012 and 2018. The total number of hospital discharges due to OA was of 78,700. The distribution by gender was similar over the years (∼ 40% and 60% among men and women respectively). Adults aged between 65 and 79 years were the most affected, and their average rate was of 2,046 per 100 thousand discharges. It was also the group that presented the highest increase (60%) in rate from 2012 to 2018. The Metropolitan Region (291.7 discharges) and Valparaíso (89.6 discharges) presented the highest rates in Chile. The hip (56.6%) and knee (31%) were the most frequent locations of OA, which presented similar distribution by gender, age and geography when compared with the total discharges due to OA.

Conclusions Hospital discharges due to OA in Chile increased between 2012 and 2018, preferentially in cases of hip and knee-joint OA in the group of elderly women in the central area of the country

Level of evidence: Descriptive study.

Keywords

osteoarthritis - prevalence - hospital discharges - Chile - hip osteoarthritis - knee osteoarthritis

Introduction

Osteoarthritis (OA) is characterized by progressive loss of articular cartilage, marginal bone hypertrophy (osteophytes), and changes in the synovial membrane.[1] [2] Its etiology is not fully understood,[2] although several factors involved in its pathogenesis, including biomechanical aspects (overload or physical effort), proinflammatory mediators (interleukin 1 [IL-1], tumor necrosis factor alpha [TNF-α]), and intra-articular proteases (protein-degrading enzymes) are known.[3] All of these factors induce an inflammation of the articular cartilage, which, in its chronic manifestation, becomes the fundamental component of the pathophysiology of OA.[2] [3] [4]

There are different ways to classify OA: using radiological, clinical, or anatomical criteria,[4] as well as classifying it according to the affected joints. Osteoarthritis can occur in “typical” joints (hip, knee, hand), when it usually corresponds to the primary (age-related) form of the disease. On the other hand, OA may affect “atypical” joints (metacarpophalangeal, elbow, ankle) in secondary forms of the disease (that is, those related to other conditions).[5] The main clinical manifestations of OA include pain, stiffness, and limited range of motion of the affected joints, and[6] progression results in deformities and macrostructural changes.[7] In addition, OA is associated with significant morbidity, including functional disability. It is the most common cause of permanent disability worldwide,[8] negatively impacting the quality of life of affected subjects.[9]

The age distribution of OA indicates that the group with the lowest prevalence consists of subjects younger than 40 years of age;[10] OA is infrequent in people aged under 20 years. The prevalence rates increase among people aged between 40 and 60 years, reaching the highest rates in elderly subjects (> 60 years old).[11] Furthermore, OA occurs predominantly in women.[7] [9] In fact, it has been estimated that 18% of 60-year-old women present symptomatic OA, compared to 9.6% of men in the same age range.[12] According to location, OA incidence is higher in hips and knees, particularly in developed countries.[9]

In the United States alone, it has been estimated that about 27 million people were affected by OA in 2014.[4] On the other hand, the prevalence of knee OA diagnosed according to radiographic or clinical criteria was of 25.4% or 15.4% respectively, in a study from Sweden published in 1970.[13] In Latin America, the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) reports a prevalence of OA of 10.5% in Mexico,[14] 4.1% in Brazil,[15] and 14.4% in Peru in subjects older than 35 years of age.[16] In 2019 in Chile, OA accounted for 16.1% of the causes of chronic pain, ranking second, behind low back pain (22.1%).[17] Despite these figures, detailed epidemiological studies by region are scarce in Latin America.

In Chile, the implementation of the set of benefits called Explicit Guarantees in Health (Garantías Explícitas en Salud, GES, in Spanish) assures access to healthcare for people with certain conditions, which have been selected due to their high health and social impacts. These guarantees include the medical treatment of mild to moderate hip and knee OAs in people over 55 years old, but only include the surgical treatment of hip OA in subjects older than 65 with severe functional limitation (Decree 170, Chilean Ministry of Health, 2005).[18] In addition, official clinical guidelines from the Chilean Ministry of Health[19] make recommendations on OA management. However, there are no recent updates including, for instance, epidemiological data on the importance of OA in Chilean public health. The Department of Health Statistics and Information (Departamento de Estadísticas e Información en Salud, DEIS, in Spanish) of the Chilean Ministry of Health reports the annual number of hospital discharges at a national level, in addition to figures according to geography and gender. These reports enable the evaluation of OA-related hospital discharges, and show that the vast majority of patients received surgical treatment, including those with surgically-treated hip OA covered by the GES, and those with knee OA who also underwent surgical treatment but with no GES coverage.

Therefore, the present study aims to describe the temporal trend and distribution according to gender, age, and geographic location of OA-related hospitalizations in Chile from 2012 to 2018. In addition, we describe he most frequent hospital discharges according to the anatomical location of the OA.

Materials and Methods

The present is a retrospective, descriptive, population-based study of hospital discharges due to OA from 2012 to 2018 in Chile. Records were downloaded from the DEIS public database.

For the search, we selected the databases that corresponded to the study period according to cause and age. In these databases, conditions are coded as per the tenth revision of the International Classification of Diseases (ICD-10). Records with codes ranging from M15 to M19 were used, which correspond to OA and its classification, namely polyarthrosis (M15); coxarthrosis (M16); gonarthrosis (M17); arthrosis of first carpometacarpal joint (M18); and other arthroses (M19).

Rates per 100 thousand hospital discharges were calculated using the following formula:

in which X indicates the category analyzed (gender, age, location).

Hospital discharge rates are presented according to gender, age, anatomical classification, and geographic location, along with percentages. Finally, emphasis is placed on the description of the two most frequent OAs per anatomical location.

A secondary database was developed to facilitate rate and percentage calculations, using the Microsoft Excel (Microsoft Corp., Redmond, WA, US) software. Moreover, graphs were made using the GraphPad Prism (GraphPad Software, Inc., San Diego, CA, US), version 8, and Infogram (Prezi, San Francisco, CA, US) softwares.

Results

A total of 11,622,605 hospital discharges occurred in Chile during the study period, with slight annual variations ranging from 1,670,447 total discharges in 2012 to 1,669,602 in 2018 ([Table 1]).

Table 1

	2012		2013		2014		2015		2016		2017		2018
Total hospital discharges	1,670,447		1,676,937		1,660,150		1,671,054		1,637,265		1,637,150		1,669,602
Osteoarthritis, N (x100 thousand discharges)	9,296	(556.50)	9,384	(559.59)	9,032	(544.05)	10,856	(649.65)	11,820	(721.94)	13,349	(815.38)	14,963	(896.20)
Males, n (% osteoarthritis)	3,798	(41)	3,693	(39)	3,695	(41)	4,490	(41)	4,750	(40)	5,188	(39)	6,074	(41)
Females, n (% osteoarthritis)	5,498	(59)	5,691	(61)	5,337	(59)	6,365	(59)	7,070	(60)	8,161	(61)	8,889	(59)

The OA-related hospital discharge rates showed a clear upward trend from 2012 to 2018, from 556.5 in 2012 to 896.2 for every 100 thousand total discharges in 2018. There were 78,700 hospitalizations due to OA. Over the years, the gender distribution of OA hospitalizations was consistent, with an average rate of 40% among males and 60% among females ([Table 1]), that is, 31,688 men and 47,011 women hospitalized for OA during the period.

When analyzing OA-related discharges per age, rates tended to rise in all age groups ([Table 2]). Osteoarthritis was specifically more frequent in subjects aged from 45 to more than 80 years, with an average rate of 3,994 per 100 thousand hospital discharges. This group consisted mainly of people aged between 65 and 79 years, with an average rate of 2,046 per 100 thousand discharges. This was also the group with the highest increase, with a 60% growth rate from 2012 to 2018, a year when over 6,800 hospital discharges were recorded ([Table 2]).

Table 2

Age (years)	2012	2013	2014	2015	2016	2017	2018
< 20	24.6	28.7	31.7	35.3	40.0	26.8	31.3
20–44	172.7	156.7	157.7	176.2	202.3	184.6	204.5
45–64	1063.5	987.3	975.2	1080.0	1218.0	1375.5	1544.3
65–79	1658.7	1729.3	1644.7	2059.9	2131.8	2451.3	2648.8
> 80	648.8	716.2	692.3	763.3	825.2	887.1	863.3

Regarding the distribution of OA across the regions of Chile, the central area of the country concentrated the highest number of OA-related hospital discharges. In contrast, the extreme regions, namely the northern and southern zones, showed the lowest rate of OA-related hospital discharges ([Figure 1A]). The regions with highest average rates were the Metropolitan Region (291.7 discharges) and the Valparaíso Region (89.6 discharges); the lowest rates were found in the Aysén Region (4.2 discharges) and the Arica and Parinacota Region (7.6 discharges).

Figure 1 Osteoarthritis (OA) in Chile from 2012 to 2018. Rates per 100 thousand hospital discharges according to data from the Department of Health Statistics and Information (DEIS) of the Ministry of Health of Chile. (A) Rates of OA in Chile from 2012 to 2018. The colors represent distribution by rate. (B) Difference in OA rates from 2018 to 2012 in Chile. The sizes of the bars represent the increase in rates from 2012 to 2018.

In a targeted analysis of the difference in rates from 2012 to 2018 to assess the magnitude of the increase, we observed that hospital discharges increased in most Chilean regions. The greatest difference was observed on the Metropolitan and Bío-Bío Regions ([Figure 1B]). In addition, the rate for every 100 thousand discharges in the Araucanía Region increased 5.5-fold during the study period, followed by the Maule Region (2.5-fold).

The topographic classification of OA presented little variability considering the total discharges ([Table 3]). Discharges due to coxarthrosis (hip OA) and gonarthrosis (knee OA) corresponded, on average, to 56.6% and 31% respectively of the total discharges registered on the DEIS database with an OA diagnosis. As such, we described the situation of these OA locations regarding their evolution over time and according to gender, age, and geographic distribution.

Table 3

Arthrosis	2012	2013	2014	2015	2016	2017	2018
Coxarthrosis (%)	57.1	55.0	58.7	57.2	56.0	57.1	55.0
Gonarthrosis (%)	28.2	31.0	28.1	31.5	31.1	32.1	35.3
Other arthroses (%)	12.8	12.3	11.5	10.1	11.6	9.6	8.6
Polyarthrosis (%)	1.2	1.1	1.1	0.7	0.5	0.5	0.4
Osteoarrthritis of the first carpometacarpal joint (%)	0.7	0.6	0.6	0.5	0.7	0.7	0.7

During the analyzed period, more than 44 thousand hospitalizations due to coxarthrosis were registered in Chile, with a temporal increase of 80%. The total number of discharges in 2018 was 493 per 100 thousand ([Figure 2A]). Similar to OA discharges, the rate of coxarthrosis-related discharges was higher among women (62%) than among men (38%), with more than 27 thousand discharges of affected women ([Figure 2B]).

Figure 2 Hip osteoarthritis (coxarthrosis) in Chile from 2012 to 2018. Rates per 100 thousand hospital discharges according to data from the Department of Health Statistics and Information (DEIS) of the Ministry of Health of Chile. (A) Evolution of the rate of coxarthrosis. (B) Coxarthrosis rate per gender. (C) Coxarthrosis rate per age group in 2012, 2015 and 2018. The colors represent age groups.

Coxarthrosis-related discharges increased in all age groups, with an average increase of 29% from 2012 to 2015, and of 27% from 2015 to 2018. In addition, in subjects younger than 20 years of age, the discharge rate doubled from 2012 to 2018. On the other hand, this rate increased by 59% in subjects aged between 65 and 79 years ([Figure 2C]).

Gonarthrosis was recorded in 24,728 hospital discharges during the period analyzed. A temporal analysis indicated an increase of more than two-fold in hospital discharges, reaching a rate of 316 per 100 thousand in 2018 ([Figure 3A]). Its gender distribution was similar to that of coxarthrosis, with the highest rates among females ([Figure 3B]). Regarding age, subjects aged between 65 and 79 years showed the highest rate, with more than 5,600 discharges in 2012, 2015, and 2018 ([Figure 3C]).

Figure 3 Knee osteoarthritis (gonarthrosis) in Chile from 2012 to 2018. Rates per 100 thousand hospital discharges according to data from the Department of Health Statistics and Information (DEIS) of the Ministry of Health of Chile. (A) Evolution of the rate of gonarthrosis. (B) Gonarthrosis rate per gender. (C) Gonarthrosis rate per age group in 2012, 2015 and 2018. The colors represent age groups.

Geographically, knee and hip OAs had similar a distribution, with increased rates in almost all regions ([Figure 4A] and [4B]). The highest number was found in the Metropolitan Region, with more than 2,200 discharges for coxarthrosis and more than 3,400 for gonarthrosis. In addition, in gross numbers, the Metropolitan, Bío-Bío and Maule regions presented the greatest difference in rates ([Figure 4]).

Figure 4 Hip (coxarthrosis) and knee (gonarthrosis) osteoarthritis in Chile from 2012 to 2018. Rates per 100 thousand hospital discharges according to data from the Department of Health Statistics and Information (DEIS) of the Ministry of Health of Chile. (A) Difference in coxarthrosis rates per region. (B) Difference in knee osteoarthritis rates per region. The sizes of the bars represent the increase in rates from 2012 to 2018.

Finally, we analyzed the magnitude of the increase by region; Araucanía experienced the greatest increase, of 7.2-fold, in coxarthrosis-related discharge rates. Maule (5.2-fold) and Araucanía (4.7-fold) were the regions with the greatest increase in gonarthrosis-related hospital discharges.

Discussion

There were 78,700 OA-related hospital discharges throughout Chile from 2012 to 2018. In the present study, we showed the evolution of this condition according to official data from the Ministry of Health, revealing a sustained upward trend mainly in the southcentralregion of the country, and mainly affecting adult women. The most frequent conditions were coxarthrosis and gonarthrosis.

Similar studies conducted in Sweden[20] and the United Kingdom[21] reported a general increase in OA-related hospitalizations, in addition to an upward trend from 1998 to 2018. Osteoarthritis affects mainly women, and multiple factors explain this phenomenon, including the higher frequency of obesity, lower muscle tone, and greater joint laxity.[22] Furthermore, its prevalence is age-dependent, being higher in subjects older than 50 years and reaching a plateau at the eight decade of life.[9] The reason for this plateau is unknown, but joint replacement surgery may be more complex in elderly populations.[20]

Regarding epidemiological evolution, a Swedish study[20] showed that hip OA was responsible for the highest proportion of OA-related admissions from 1998 to 2015. In addition, in the United Kingdom, the incidence of hip OA showed a marked increase (3.8% per year) from 2000 to 2018.[21] These findings confirm the epidemiological importance of OA, which is also demonstrated in the present study.

Results show that the highest number of discharges occurred in the southcentral region of Chile. According to the 2017 census,[22] 62.4% of the Chilean population is concentrated at the Metropolitan, Bío-Bío, and Valparaíso regions, in decreasing order. Therefore, the higher rates observed in these areas would be partially explained by the greater populational density and access to specialty hospitals. Based on the latter, a study[23] on physician distribution within Chile revealed that it is similar to the populational distribution, with 87.7% of all doctors and the largest number of traumatologists (88.93%) in the central and southcentral regions. This would explain the lack of specialists in more peripheral regions, resulting in the referral of patients to the central and southcentral regions for their surgical interventions. Additionally, the greater concentration of the general population and hospital facilities in the southcentral zone should be considered. Other potential causes include the different distribution of OA risk factors, such as obesity, ethnicity, or physical effort, along with the number of surgeons, surgical waiting times, the wishes of the patient, socioeconomic situation, and cultural norms.[19] [23] [24]

Regarding location, although OA can affect any joint, the knee and hip joints are most frequently involved.[19] [25] The prevalence of hip OA in adults older than 45 years of age has been reported as 9.2% in the United States in 2009,[26] 0.9% in Greece in 2006,[27] and 23% in Croatia in 2000.[27] Although we did not find individualized reports from Latin American countries focused on this age group, in 2015, hip OA affected 1.3% of older adults (average age: 62.5 years old) in a study including 13 Latin American countries.[28] It is worth mentioning that the rates reported correspond to the total population, not to total hospital discharges, as in the present study. Therefore, comparisons are difficult to make. However, it is a primary analysis that provides a clear picture of hip OA in Chile.

Hip OA affects more women, predominantly those over 45 years old.[19] [20] [26] This may be due to the protective effect of estrogens at an early age.[25] [29] Reinforcing what was previously described, but focusing on the age range of the affected population, a systematic review[27] of the prevalence of hip OA per radiographic criteria reported a gradual increase with advancing age, with higher numbers after the age of 60 years, confirming previous evidence in other populations.[19] [27] The causes include changes in the functional status of chondrocytes, ligaments, muscles, and joint viscoelasticity.[29] [30]

An important finding of the present study is the 2-fold increase in the rate of hip OA-related hospital discharges in subjects younger than 20 years of age.. Despite this increase, the rate in this age range remains very low. A constant growth in OA numbers among people aged 15 to 49 years have been described.[31] Additionally, an increase in the prevalence of hip OA in subjects younger than 40 years old has been shown.[19] [20] [31] It is difficult to compare these previous studies between 1998 and 2018 with our findings, but, as far as we know, these are the only published data showing epidemiological evolution in young individuals. Although the potential causes for this increase in the young population remain unknown, first we need to rule out any diagnostic error. This is critical, because the ICD-10 does not consider diagnoses such as hip transient synovitis, epiphysiolysis of the hip, or Perthes disease, which are common in this age group.[32] In addition, other potential causes are femoroacetabular impingement (FAI)[20] and sports injuries, resulting in an increase in surgical indications for these patients.[19]

The increase in hip (and knee) OA hospitalizations in the Araucanía Region stands out. We do not know the reasons for this increase, but, since indigenous people comprise 34.3% of this population,[33] a genetic component may play a role. Another aspect could be the high prevalence of obesity (56.1%) and type-2 diabetes among the Mapuche population,[34] [35] particularly in women. It is known that obesity is a risk factor for hip OA.[19] [29] Another potential explanation is the high biomechanical stress of the hip joint in this population, who mainly work at the silvicuture, agriculture, and livestock sectors,[24] which require great physical effort.

Knee OA is defined by both clinical and radiographic aspects.[36] International studies[20] [28] [37] show that knee OA has the highest prevalence in comparison to other types of OA. In particular, the Framingham study[36] showed that the prevalence of knee OA was of 4.9% in 1987 (in people aged ≥ 26 years old). There is no data on the prevalence of knee OA in the general Latin American population. However, in a study[28] published in 2015 analyzing data from more than 3 thousand Latin American patients, knee OA corresponded to 31.2% of the cases of OA. Despite the different measurements, data from this study corroborate that the knee is a very important OA location, accounting for an average of 31% of hospital discharges due to OA in Chile.

Similarly, in the United Kingdom, the incidence of knee OA increased, on average, 2.9% per year from 2000 to 2018.[20] Unlike this study,[20] our report determined an average increase of 13% in the rate of knee OA-related hospital discharges during the analyzed period. The possible explanations for these findings are the demographic and ethnic differences of the Chilean compared to the English population. In addition, other variables not investigated could contribute, including the diagnostic criteria and the surgical experience of the medical team.[20] On the other hand, previous studies[19] [20] revealed that hospitalizations due to knee OA are more prevalent in female and older subjects (65 to 79 years old), which is consistent with the present study.

We recognize that the present study has limitations, such as the fact that it shows hospital discharge rates, not populational data, which makes comparisons difficult. Similarly, the database does not include outpatients. Furthermore, since we used a general database, and not a case-by-case analysis, we cannot discriminate between readmissions, recurrences, or new procedures performed in the same patient. There is an unavoidable inclusion bias when using a hospital discharge database, since the GES includes patients with surgically-treated hip OA alone. On the other hand, the other group of patients who undergo surgery for their condition are those with knee OA, who are not covered by GES, and are placed on longer waiting lists. As such, despite the importance of this database, it does not enable discriminations between a temporal increase in OA frequency or a certain benefit. In addition, this public database does not provide details on different joints affected by OA requiring hospitalization. Even so, the results provide a general, coherent picture regarding OA occurrence among the Chilean population. The present is the only study showing OA distribution by anatomical location, gender, age, and geographic location within the Chilean territory.

In conclusion, hospitalizations for OA in Chile from 2012 to 2018 increased substantially and progressively, mostly affecting the hip and knee joints of elderly women from the central region of the country. The two-fold increase in the OA rate among young individuals during this period is also striking. In Chile, OA-related evidence is scarce, and further research are required regarding the clinical presentation, epidemiological evolution, and societal impact of this prevalent condition. Our results increase the knowledge on this little-studied condition in our country, enabling the development of new public health measures, and it also highlights the need to improve code records in outpatient care.

Conflicto de Intereses

Los autores no presentan conflicto de intereses que declarar.

• References

• 1 Cillero Pastor B, López Armada M, Caramés B, Blanco García F. Fisiopatología de la artrosis: ¿Cuál es la actualidad?. Rev Esp Reumatol 2004; 31 (06) 379-393
• 2 Martínez Figueroa R, Martínez Figueroa C, Calvo Rodriguez R, Figueroa Poblete D. Osteoartritis (artrosis) de rodilla. Rev. Chil. Ortop. y Traumatol. 2015; 56 (03) 45-51
• 3 Hunter DJ, McDougall JJ, Keefe FJ. The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am 2008; 34 (03) 623-643
• 4 Nelson AE. Osteoarthritis year in review 2017: clinical. Osteoarthritis Cartilage 2018; 26 (03) 319-325
• 5 Garriga XM. Definición, etiopatogenia, clasificación y formas de presentación. Aten Primaria 2014; 46 (Suppl. 01) 3-10
• 6 Moskowitz RW. The burden of osteoarthritis: clinical and quality-of-life issues. Am J Manag Care 2009; 15 (8, Suppl) S223-S229
• 7 Kloppenburg M, Berenbaum F. Osteoarthritis year in review 2019: epidemiology and therapy. Osteoarthritis Cartilage 2020; 28 (03) 242-248
• 8 Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 2013; 21 (09) 1145-1153
• 9 Neogi T, Zhang Y. Epidemiology of osteoarthritis. Rheum Dis Clin North Am 2013; 39 (01) 1-19
• 10 Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 2006; 20 (01) 3-25
• 11 Altman RD. Early management of osteoarthritis. Am J Manag Care 2010; 16 (Suppl Management): S41-S47
• 12 Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81 (09) 646-656
• 13 Danielsson L, Hernborg J. Morbidity and mortality of osteoarthritis of the knee (gonarthrosis) in Malmö, Sweden. Clin Orthop Relat Res 1970; 69 (69) 224-226
• 14 Peláez-Ballestas I, Sanin LH, Moreno-Montoya J. et al; Grupo de Estudio Epidemiológico de Enfermedades Músculo Articulares (GEEMA). Epidemiology of the rheumatic diseases in Mexico. A study of 5 regions based on the COPCORD methodology. J Rheumatol Suppl 2011; 86: 3-8
• 15 Senna ER, De Barros AL, Silva EO. et al. Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach. J Rheumatol 2004; 31 (03) 594-597
• 16 Gamboa DR. et al. Prevalencia de enfermedades reumatologicas y discapacidad en una comunidad urbano-marginal : resultados del primer estudio CoPCord en el Perú. Rev Per Reum. 2009; 15 (01) 40-46
• 17 Bilbeny N. Dolor Crónico En Chile. Rev Med Clin Las Condes 2019; 30 (06) 397-406
• 18 GOBIERNO DE CHILE. Ministerio de Salud. Decreto 170. Aprueba Garantias Explicitas en Salud del Regimen General de Garantias en Salud. 2005
• 19 MINISTERIO DE SALUD. Guía Clínica Tratamiento Médico en personas de 55 años y más con artrosis de cadera y/o rodilla, leve o moderada. 2009
• 20 Kiadaliri AA, Rinaldi G, Lohmander LS, Petersson IF, Englund M. Temporal trend and regional disparity in osteoarthritis hospitalisations in Sweden 1998-2015. Scand J Public Health 2019; 47 (01) 53-60
• 21 Morgan OJ, Hillstrom HJ, Ellis SJ. et al. Osteoarthritis in England: Incidence Trends From National Health Service Hospital Episode Statistics. ACR Open Rheumatol 2019; 1 (08) 493-498
• 22 Solis Cartas U. et al. Rasgos demográficos en la osteoartritis de rodilla. Rev. Cuba. Reumatol . RCuR 2015; 17 (01) 32-39
• 23 Instituto Nacional de Estadísticas. Resultados definitivos Censo 2017(Censo de Población y Vivienda 2017). https://www.censo2017.cl/wp-content/uploads/2017/12/Presentacion_Resultados_Definitivos_Censo2017.pdf
• 24 Guillou M, Carabantes C J, Bustos F V. Disponibilidad de médicos y especialistas en Chile. Rev Med Chil 2011; 139 (05) 559-570
• 25 Oficina de Estudios y Políticas Agrarias. Region de la Araucanía, Informacion regional 2018. 2018
• 26 Felson DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev 1988; 10 (01) 1-28
• 27 Lespasio MJ, Sultan AA, Piuzzi NS. et al. Hip Osteoarthritis: A Primer. Perm J 2018; 22: 17-084
• 28 Dagenais S, Garbedian S, Wai EK. Systematic review of the prevalence of radiographic primary hip osteoarthritis. Clin Orthop Relat Res 2009; 467 (03) 623-637
• 29 Reginato AM, Riera H, Vera M. et al; Pan-American League of Associations for Rheumatology (PANLAR) Osteoarthritis Study Group. Osteoarthritis in Latin America: Study of Demographic and Clinical Characteristics in 3040 Patients. J Clin Rheumatol 2015; 21 (08) 391-397
• 30 Andrianakos AA, Miyakis S, Trontzas P. et al; ESORDIG study group. The burden of the rheumatic diseases in the general adult population of Greece: the ESORDIG study. Rheumatology (Oxford) 2005; 44 (07) 932-938
• 31 Ingvarsson T. Prevalence and inheritance of hip osteoarthritis in Iceland. Acta Orthop Scand 2001; 72 (01) 1-46
• 32 Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. Hip and knee osteoarthritis affects younger people, too. J Orthop Sports Phys Ther 2017; 47 (02) 67-79
• 33 Hernández BJC. Coxalgia en el niño: Diagnóstico diferencial. Rev Chil Pediatr 2004; 75 (02) 177-180
• 34 Biblioteca del Congreso Nacional de Chile. Indicadores socio-demográficos y económicos Región de La Araucanía. 2017
• 35 Pérez-Bravo F, Carrasco E, Santos JL, Calvillán M, Larenas G, Albala C. Prevalence of type 2 diabetes and obesity in rural Mapuche population from Chile. Nutrition 2001; 17 (03) 236-238
• 36 Pérez F, Carrasco E, Santos JL, Calvillán M, Albala C. Prevalencia de obesidad, hipertensión arterial y dislipidemia en grupos aborígenes rurales de Chile. Rev Med Chil 1999; 127 (10) 1169-1175
• 37 Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 1987; 30 (08) 914-918
• 38 Schäfer T, Pritzkuleit R, Jeszenszky C. et al. Trends and geographical variation of primary hip and knee joint replacement in Germany. Osteoarthritis Cartilage 2013; 21 (02) 279-288

Publication History

Received: 21 August 2020

Accepted: 04 February 2021

Article published online:
30 September 2021