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Risk factors for surgery due to rotator cuff disease in a population-based cohort
Elizabeth L Yanik1, Graham A Colditz2, Rick W Wright3
1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Assistant Professor, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Insights
Older age, male sex, higher BMI, and demanding jobs increase rotator cuff disease (RCD) surgery risk. Modifiable factors like obesity and occupational demands offer potential public health intervention targets.
Area of Science:
- Orthopedics
- Epidemiology
- Public Health
Background:
- Rotator cuff disease (RCD) has unclear risk factors and treatment pathways.
- Establishing these factors is crucial for effective RCD management and prevention.
Purpose of the Study:
- To investigate the association between various risk factors and the incidence of rotator cuff disease (RCD) surgery.
- To analyze a large UK population-based cohort to identify predictors of RCD surgery.
Main Methods:
- Utilized the UK Biobank cohort (40-69 years) linked to NHS inpatient records.
- Employed multivariate Cox proportional hazards regression to assess risk factors.
- Considered age, sex, race, education, deprivation, BMI, occupational demands, and smoking exposure.
Main Results:
- Increased age, male sex, non-white race, lower deprivation, and higher BMI were linked to higher RCD surgery risk.
- Higher occupational physical demands significantly increased RCD surgery rates (HRs 1.4-2.1).
- Former smokers had higher RCD surgery rates (HR 1.23); current smokers did not differ from never smokers.
Conclusions:
- Identified significant independent risk factors for RCD surgery, including age, sex, BMI, deprivation, and occupational physical demands.
- Highlights modifiable risk factors, suggesting potential for public health interventions targeting obesity and occupational exposures.
- Findings support public health strategies to mitigate the healthcare burden of rotator cuff disease.
Aims:
Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort.
Methods:
A population-based cohort of people aged between 40 and 69 years in the UK (the UK Biobank) was studied. People who underwent surgery for RCD were identified through a link with NHS inpatient records covering a mean of eight years after enrolment. Multivariate Cox proportional hazards regression was used to calculate hazard ratios (HRs) as estimates of associations with surgery for RCD accounting for confounders. The risk factors which were considered included age, sex, race, education, Townsend deprivation index, body mass index (BMI), occupational demands, and exposure to smoking.
Results:
Of the 421,894 people who were included, 47% were male. The mean age at the time of enrolment was 56 years (40 to 69). A total of 2,156 people were identified who underwent surgery for RCD. Each decade increase in age was associated with a 55% increase in the incidence of RCD surgery (95% confidence interval (CI) 46% to 64%). Male sex, non-white race, lower deprivation score, and higher BMI were significantly associated with a higher risk of surgery for RCD (all p < 0.050). Greater occupational physical demands were significantly associated with higher rates of RCD surgery (HR = 2.1, 1.8, and 1.4 for 'always', 'usually', and 'sometimes' doing heavy manual labour vs 'never', all p < 0.001). Former smokers had significantly higher rates of RCD surgery than those who had never smoked (HR 1.23 (95% CI 1.12 to 1.35), p < 0.001), while current smokers had similar rates to those who had never smoked (HR 0.94 (95% CI 0.80 to 1.11)). Among those who had never smoked, the risk of surgery was higher among those with more than one household member who smoked (HR 1.78 (95% CI 1.08 to 2.92)). The risk of RCD surgery was not significantly related to other measurements of secondhand smoking.
Conclusion:
Many factors were independently associated with surgery for RCD, including older age, male sex, higher BMI, lower deprivation score, and higher occupational physical demands. Several of the risk factors which were identified are modifiable, suggesting that the healthcare burden of RCD might be reduced through the pursuit of public health goals, such as reducing obesity and modifying occupational demands. Cite this article: Bone Joint J 2020;102-B(3):352-359.
