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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (3): 527-534. doi: 10.19723/j.issn.1671-167X.2020.03.020

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Epidemiological study of bone and joint injury based on urban medical insurance database

Si-wei DENG1,Ze-yi CHEN2,Zhi-ke LIU1,Jian WANG2,Lin ZHUO3,Shuang-qing GAO4,Jia-kuo YU2,Si-yan ZHAN1,△()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
    3. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
    4. Beijing North Medical & Health Economic Research Center, Beijing 100021, China
  • Received:2020-02-05 Online:2020-06-18 Published:2020-06-30
  • Contact: Si-yan ZHAN E-mail:siyan-zhan@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81973146)

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Abstract:

Objective: To estimate the prevalence rate of bone and joint injury in China and to describe the three-dimension distribution of the disease (area, time and people).Methods: Based on a cross-sectional design, a retrospective study was conducted by using Chinese basic medical insurance database from January 1, 2013 to December 31, 2017 to analyze the epidemiological characteristics of bone and joint injury. The prevalence rate of bone and joint injury in each city was calculated, and then using meta-analyses to estimate the pooled prevalence of each area and the whole country. The pooled prevalence rates were compared among the different groups of populations, in terms of geographical area, time and population characteristics (age and gender).Results: A total of 28 419 264 subjects were included in this study, including 705 793 patients with bone and joint injury. From 2013 to 2017, in Chinese basic medical insurance database, the overall prevalence rate of bone and joint injury was 141.5(95%CI: 90.4-203.7) per 10 000 population, and the prevalence rates of non-specific or polyarticular disease, knee disease, and shoulder disease were 101.6 (95%CI: 63.5-148.4)per 10 000 population, 22.5(95%CI:15.1-31.4)per 10 000 population and 10.9 (95%CI: 6.4-16.4)per 10 000 population. The prevalence rates varied across the areas, the highest rate was observed in North China, with the prevalence of 310.6 (95%CI: 12.6-989.7) per 10 000 population, and the lowest rate was observed in Southwest China, with the prevalence of 59.0 (95%CI: 37.5-85.2) per 10 000 population. The prevalence rate of bone and joint injury increased over the study period, from 111.1 (95%CI: 56.0-182.5)per 10 000 population in 2013 to 175.5 (95%CI: 116.8-245.5)per 10 000 population in 2017. The prevalence of bone and joint injury in the female population was 149.1 (95%CI: 94.2-215.9) per 10 000 population, which was higher than that of men [133.6(95%CI: 86.2-190.9) per 10 000 population]. The higher prevalence of knee disease, unspecified or polyarticular disease, and bone and joint injury were observed in people aged 60 years and older, while the prevalence of shoulder disease peaked in 40-59 years old people [20.6 (95%CI: 12.5-30.5) per 10 000 population].Conclusion: This study reported a relative low prevalence of bone and joint injury in China from 2013 to 2017. The prevalence increased over the study period, and the highest prevalence rate was observed in North China. The prevalence rate showed differences among different groups of populations, and higher rates were observed in females and people aged 60 years and older.

Key words: Joint, Injury, Disease, Prevalence rate, Epidemiology

CLC Number: 

  • R181.2

Table 1

The number of people and sampling ratio of 31 provinces in Chinese basic medical insurance database from 2013 to 2017"

Province The number of people include in database The number of people covered by basic medical insurance Sampling ratio/%
Anhui 193 648 88 845 340 0.218
Beijing 817 659 82 560 649 0.990
Fujian 3 249 097 89 445 848 3.632
Gansu 77 823 50 438 706 0.154
Guangdong 2 269 451 496 351 534 0.457
Guangxi 390 587 94 454 751 0.414
Guizhou 337 101 42 895 901 0.786
Hainan 50 179 19 898 496 0.252
Hebei 384 220 185 910 109 0.207
Henan 291 723 197 535 003 0.148
Heilongjiang 144 458 92 540 840 0.156
Hubei 1 599 905 135 046 786 1.185
Hunan 788 623 168 316 881 0.469
Jilin 220 926 69 009 533 0.320
Jiangsu 757 759 228 428 961 0.332
Jiangxi 1 278 921 110 707 182 1.155
Liaoning 645 367 117 701 562 0.548
Inner Mongoria 855 504 61 736 140 1.386
Ningxia 446 367 29 413 197 1.518
Qinghai 250 592 13 126 170 1.909
Shandong 474 368 411 142 358 0.115
Shanxi 121 369 76 378 786 0.159
Shaanxi 106 821 62 366 643 0.171
Shanghai 1 494 426 86 945 828 1.719
Sichuan 627 635 20 4847 778 0.306
Tianjin 564 884 52 344 187 1.079
Tibet 94 434 3 107 091 3.039
Xinjiang 391 936 46 160 791 0.849
Yunnan 1 775 649 90 228 549 1.968
Zhejiang 1 592 744 241 776 143 0.659
Chongqing 6 125 088 162 657 986 3.766

Figure 1

Population pyramid in Chinese basic medical insurance database from 2013 to 2017 (Compared with China 2010 population census data)"

Table 2

Demographic characteristics of patients with bone and joint injury in Chinese basic medical insurance database from 2013 to 2017"

Variables Total Male Female χ2 P value
Patients, n(%) 705 793 (100) 312 784 (44.32) 393 009 (55.68)
Area, n(%) 630.68 <0.001
Northeast China 21 281 (3.02) 8 783 (2.81) 12 498 (3.18)
East China 138 191 (19.58) 62 439 (19.96) 75 752 (19.27)
North China 306 502 (43.43) 132 251 (42.28) 174 251 (44.34)
South and central China 162 162 (22.98) 73 222 (23.41) 88 940 (22.63)
Southwest China 59 861 (8.48) 28 524 (9.12) 31 337 (7.97)
Northwest China 17 796 (2.52) 7 565 (2.42) 10 231 (2.60)
Year, n(%) 25 764.57 <0.001
2013 103 119 (14.61) 47 046 (15.04) 56 073 (14.27)
2014 125 062 (17.72) 52 005 (16.63) 73 057 (18.59)
2015 121 024 (17.15) 53 138 (16.99) 67 886 (17.27)
2016 156 236 (22.14) 69 836 (22.33) 86 400 (21.98)
2017 200 352 (28.39) 90 759 (29.02) 109 593 (27.89)
Age/years, n(%) 4 421.50 <0.001
0-17 18 244 (2.58) 10 761 (3.44) 7 483 (1.90)
18-39 131 112 (18.58) 65 968 (21.09) 65 144 (16.57)
40-59 283 189 (40.13) 118 960 (38.03) 164 229 (41.79)
≥60 271 225 (38.43) 116 041 (37.10) 155 184 (39.49)
Missing 2 023 (0.29) 1 054 (0.34) 969 (0.25)

Table 3

Demographic characteristics of patients with bone and joint injury in Chinese basic medical insurance database from 2013 to 2017"

Variables Total Male Female χ2 P
Type of medical insurance, n(%) 100.14 <0.001
Urban resident basic medical insurance 131 231 (18.59) 59 782 (19.11) 71 449 (18.18)
Urban employee basic medical insurance 574 562 (81.41) 253 002 (80.89) 321 560 (81.82)
Disease type, n(%) 1 429.13 <0.001
Knee disease 106 342 (13.61) 41 824 (12.24) 64 518 (14.68)
Shoulder disease 69 454 (8.89) 30 872 (9.03) 38 582 (8.78)
Ankle disease 28 177 (3.61) 13 577 (3.97) 14 600 (3.32)
Hip disease 4 161 (0.53) 1 762 (0.52) 2 399 (0.55)
Elbow disease 2 606 (0.33) 1 312 (0.38) 1 294 (0.29)
Wrist disease 4 131 (0.53) 1 730 (0.51) 2 401 (0.55)
Hand and foot diseases 7 343 (0.94) 3 625 (1.06) 3 718 (0.85)
Pelvic disease 184 (0.02) 74 (0.02) 110 (0.03)
Spinal disease 17 921 (2.29) 8 721 (2.55) 9 200 (2.09)
Unspecified or polyarticular disease 541 003 (69.24) 238 306 (69.72) 302 697 (68.87)

Table 4

Regional variation of patients with bone and joint injury in Chinese basic medical insurance database from 2013 to 2017"

Disease type Prevalence (per 10 000 population)
China Northeast China East China North China South and central China Southwest China Northwest China
Bone and joint injury 141.5
(90.4,203.7)		 111.5
(46.4,204.4)		 126.7
(61.4,215.0)		 310.6
(12.6,989.7)		 189.8
(93.4,320.1)		 59.0
(37.5,85.2)		 119.8
(76.8,171.9)
Knee disease 22.5
(15.1,31.4)		 18.0
(8.5,31.9)		 20.4
(12.4,30.5)		 41.1
(1.6,133.8)		 28.2
(15.2,45.2)		 11.3
(6.0,18.2)		 23.7
(13.6,36.9)
Shoulder disease 10.9
(6.4,16.4)		 7.7
(1.7,17.9)		 10.4
(3.3,21.6)		 16.9
(0.0,65.7)		 16.2
(5.5,32.6)		 7.5
(3.6,12.8)		 8.0
(3.8,13.7)
Unspecified or
polyarticular disease		 101.6
(63.5,148.4)		 83.1
(32.7,156.5)		 93.0
(43.6,160.7)		 241.7
(10.3,771.6)		 136.6
(63.8,236.9)		 36.0
(22.2,53.2)		 82.1
(50.8,120.5)

Table 5

Prevalence of bone and joint injury among different types of medical insurance in various regions Chinese basic medical insurance database from 2013 to 2017"

Area Prevalence (per 10 000 population)
Urban resident basic medical insurance Urban employee basic medical insurance
Northeast China 142.7 (93.7, 201.6) 156.5 (64.5, 287.7)
East China 142.3 (75.5, 229.8) 169.2 (81.8, 287.2)
North China 250.7 (135.3, 400.2) 399.0 (12.7, 1284.2)
South and central China 171.1 (106.9, 250.0) 268.8 (131.5, 452.9)
Southwest China 120.3 (92.3, 151.8) 73.9 (40.0, 117.9)
Northwest China 186.4 (133.1, 248.4) 147.5 (85.0, 226.8)

Figure 2

Time trend of patients with bone and joint injury in Chinese basic medical insurance database from 2013 to 2017"

Figure 3

Prevalence of patients with bone and joint injury by gender in Chinese basic medical insurance database from 2013 to 2017"

Figure 4

Prevalence of patients with bone and joint injury by age group in Chinese basic medical insurance database from 2013 to 2017"

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