Background/Purpose: Osteoarthritis (OA) is the most common type of arthritis which classically affects multiple joints, mainly the knees. About 595 million people worldwide suffer from OA which affects older individuals after the age of 50; females more frequently affected than males. The reason for the increased risk in females is suspected to be multifactorial and possibly related to genetics and environment. Many studies have found that women suffer from more severe disease compared to men. An observational, retrospective cohort study was conducted using the TriNetX database, which uses electronic health records from over 140 global collaborative networks, to explore gender differences in the diagnostic evaluation, treatment, and outcomes in patients with OA of the knees.

Methods: Inclusion criteria were limited to patients above the age of 65, assigned the ICD-10 code M17 for the diagnosis of OA of the knee. Individuals with RA, osteoporosis, gout, FM, polymyalgia rheumatica, AS and patients on steroids were excluded. Two cohorts were studied: females and males over the age of 65. The index event was defined as the initial appearance of the diagnosis of OA of the knee. Propensity matching was used for age, race/ethnicity and other comorbidities at the time of the index event. The outcomes evaluated included falls, fractures, depression, anxiety, PCP Visits, hospitalizations, mortality, chronic pain, opioid use, sleep disturbances, and visits to skilled nursing facilities (SNF Visits). Patients who experienced any of these outcomes prior to the index event were excluded and both risk and risk ratio calculations were measured.

Results: The dataset included 354,678 males, and 521,319 females. After propensity matching the average age was 70. Most males and females were White, of unknown race, or Black/African American. After propensity matching, a total of 219,227 patients were excluded from both groups and the outcomes were calculated. Analysis showed a statistically significant difference for falls (RR 1.141, 95% CI 1.105-1.178, P < 0.0001), fractures (RR 1.349, 95% CI 1.29-1.41, P < 0.0001), depression (RR 1.409, 95% CI 1.369-1.451, P < 0.0001), anxiety (RR 1.507, 95% CI 1.469-1.546, P < 0.0001), and SNF visits (RR 1.226, 95% CI 1.054-1.426, P 0.0080) in females. Additionally, PCP visits (RR 0.972, 95% CI 0.952-0.992, P 0.0074), hospitalizations (RR 0.645, 95% CI 0.539-0.771, P < 0.0001), mortality (RR 0.855, 95% CI 0.819-0.893, P < 0.0001), opioid use (RR 0.648, 95% CI 0.554-0.76, P < 0.0001), and sleep disorders (RR 0.821, 95% CI 0.803-0.841, P < 0.0001) were determined to be statistically significant in males.

Conclusion: The study shows that females with OA are at higher risk for falls, fractures, depression, anxiety, and SNF visits. Men with OA are more likely to face sleep disorders, seek PCP visits, require more hospitalizations, have a higher mortality, and are more likely to be prescribed opioids, indicating that both genders face different consequences of OA, and that gender discrepancies exist. Additional research should be conducted specifically focusing on gender differences in osteoarthritis to explore potential contributive or causative factors that may explain these findings.

Table 1: Baseline Characteristics of Both Cohorts Before (Left) and After (Right) Propensity Matching

Table 2: Differences in Diagnosis, Treatment, and Clinical Outcomes of Both Cohorts

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gender-disparities-in-clinical-outcomes-among-older-adults-with-knee-osteoarthritis-a-retrospective-cohort-study/