Global, regional and national burden of osteoarthritis in 1990-2021: a systematic analysis of the global burden of disease study 2021
1990-2021 年全球、区域和国家骨关节炎负担：2021 年全球疾病负担研究的系统分析

Zihao Wang $^{2}$ , Zhikang Xiao $^{3}$ , Changhao Sun $^{1}$ , Gaoxiang $X u^{3^{*}}$ and Jianfeng ${He}^{1 *}$
Zihao Wang $^{2}$ ， Zhikang Xiao $^{3}$ ， Changhao Sun $^{1}$ ， Gaoxiang $X u^{3^{*}}$ 和 Jianfeng ${He}^{1 *}$

Abstract 抽象

Objectives To describe the prevalence and incidence of osteoarthritis as well as years lived with disability (YLDs) due to osteoarthritis in 204 countries and territories from 1990 to 2021 by age, sex and socio-demographic index (SDI, a composite of socio-demographic factors). Methods Data were acquired from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021). The burden of osteoarthritis was estimated for 204 countries and territories from 1990 to 2021 by incidence, prevalence and YLDs. All estimates are presented as numbers and age-standardised rates per 100000 population, with uncertainty intervals (Uls). All the data were analyzed by age-sex-SDI-year groups. Results In 2021, globally, the age-standardised prevalence rate of osteoarthritis increased from 6393.1 (95% UI 5683.2 to 7059.5 ) in 1990 to $6967.3 (95 %$ UI 6180.7 to 7686.1 ) in 2021.Addtionally, the age-standardised incidence rate increased from $489.8 (95 %$ UI 541.5 to 433.1 ) in 1990 to $535.0 (95 % UI 472.4$ to 592.0 $)$ in 2021. In addition, the agestandardised YLD rate of osteoarthritis increased from $222.8 (95 %$ UI 106.7 to 450.3 ) in 1990 to 244.5(95% UI 117.1 to 493.1). The global prevalence and YLDs were higher in females than in males and increased with age, peaking at the > 95 years age group. Simultaneously, a positive association was found between the age-standardised YLD rate and the SDI at the regional and national levels. Conclusions Osteoarthritis is a major public health challenge that can cause significant problems for individuals and society. The burden osteoarthritis increased in most countries between 1990 and 2021. This trend is expected to continue as life expectancy increases and the global population ages. Increasing public awareness of the risk factors and the importance of osteoarthritis management, along with providing healthcare services to the growing number of people with osteoarthritis, are recommended to manage the future burden of this disease.
目的按年龄、性别和社会人口指数（SDI，社会人口因素的综合）描述 1990 年至 2021 年期间 204 个国家和地区骨关节炎引起的骨关节炎患病率和发病率以及残疾寿命（YLD）。方法数据来自 2021 年全球疾病、伤害和风险因素负担研究（GBD 2021）。从 1990 年到 2021 年，按发病率、患病率和 YLD 估计了 204 个国家和地区的骨关节炎负担。所有估计数均以每 100000 人的数字和年龄标准化比率表示，并带有不确定性区间（Uls）。所有数据均按年龄 - 性别 - SDI -年级组进行分析。结果 2021 年，全球骨关节炎的年龄标准化患病率从 1990 年的 6393.1 （95% UI 5683.2 至 7059.5 ）增加到 $6967.3 (95 %$ 2021 $489.8 (95 %$ $535.0 (95 % UI 472.4$ $)$ 年的 UI 6180.7 至 7686.1 ）。此外，骨关节炎的年龄标准化 YLD 率从 $222.8 (95 %$ 1990 年的 UI 106.7 增加到 450.3 ）增加到 244.5 （95% UI 117.1 增加到 493.1）。女性的全球患病率和 YLD 高于男性，并且随着年龄的增长而增加，在 95 岁年龄组>达到峰值。同时，在区域和国家层面，发现年龄标准化 YLD 率与 SDI 之间存在正相关。结论骨关节炎是一项重大的公共卫生挑战，可给个人和社会带来重大问题。1990 年至 2021 年间，大多数国家的骨关节炎负担增加。随着预期寿命的增加和全球人口的老龄化，预计这一趋势将继续下去。建议提高公众对风险因素和骨关节炎管理重要性的认识，同时为越来越多的骨关节炎患者提供医疗保健服务，以管理这种疾病的未来负担。

Keywords Osteoarthritis, GBD, Global, Regional, National, SDI
关键词骨关节炎， GBD，全球，区域，国家， SDI

Introduction 介绍

As a common chronic disease, osteoarthritis not only brings physical pain to patients, but also has a profound impact on their social, economic and psychological aspects. Osteoarthritis has many harmful effects on individuals and society, including pain and functional impairment, a high disability rate, a high psychological impact, an economic burden, the consumption of medical resources, a loss of the labor force, and an increased social burden [1, 2]. A significant segment of the osteoarthritis burden is due to hip and knee osteoarthritis, which can lead to late joint replacement. Notably, studies have also shown that the incidence of osteoarthritis is on the rise even among young and physically active people [3, 4]. The worldwide osteoarthritis burden was reported using the Global Burden of Disease Study 2021 (GBD 2021) [5], but the national level of osteoarthritis was not mentioned, and these overall osteoarthritis burden estimates need to be updated from the 2020 estimate [6], due to the immense changes of the data updated in the GBD 2021. To provide comprehensive and up- todate information on osteoarthritis burden so as to give a more accurate description of the burden of osteoarthritis and to aid in the implementation of relevant policies and measures, this report presents the modeled global, regional and national level prevalence, incidence and years lived with disability (YLDs) of osteoarthritis as reported in the GBD 2021 Study, presenting counts and age-standardised rates from 1990 to 2021 by age, sex and SDI. This research could fill in the gaps in underreported data on osteoarthritis.
骨关节炎作为一种常见的慢性疾病，不仅给患者带来身体上的痛苦，而且对患者的社会、经济和心理方面也产生了深远的影响。骨关节炎对个人和社会有许多有害影响，包括疼痛和功能障碍、高残疾率、高心理影响、经济负担、医疗资源的消耗、劳动力的流失以及社会负担的增加 [1， 2]。骨关节炎负担的很大一部分是由于髋关节和膝关节骨关节炎，这可能导致晚期关节置换。值得注意的是，研究还表明，即使在年轻和身体活跃的人群中，骨关节炎的发病率也在上升 [3， 4]。使用 2021 年全球疾病负担研究（GBD 2021） [5] 报告了全球骨关节炎负担，但没有提及骨关节炎的国家水平，由于 GBD 2021 中更新的数据存在巨大变化，这些总体骨关节炎负担估计需要从 2020 年的估计 [6] 更新。为了提供有关骨关节炎负担的全面和最新信息，以便更准确地描述骨关节炎的负担并帮助实施相关政策和措施，本报告介绍了 GBD 2021 研究中报告的骨关节炎的全球、区域和国家层面的患病率、发病率和残疾寿命（YLD）模型，按年龄、性别和 SDI 列出 1990 年至 2021 年的计数和年龄标准化比率。这项研究可以填补骨关节炎数据被低估的空白。

Methods 方法

Data source 数据源

The GBD 2021 study, conducted by the Institute of Health Metrics and Evaluation (IHME), integrates all existing data and provides consistent information about the burden of diseases, injuries, risk factors and the latest global, regional and national estimates [7]. In the GBD 2021 Study, osteoarthritis of the hip, knee, hand, and others were included. For the current study, we used data from GBD 2021, a more detailed description of which has been published previously [8-10]. Specifically, GBD 2021 provides comprehensive and systematic assessments of age-specific and sex-specific mortality and 288 causes of death, 371 diseases and injuries, and 88 risk factors in 204 countries and territories, including subnational estimates for 21 countries and territories and years from 1990 to 2021.
The data obtained from the GBD 2021 for osteoarthritis included the prevalence, incidence and YLDs of 204 countries and territories and 54 regions. Osteoarthritis in GBD 2021 is defined as symptomatic osteoarthritis at
the hip, knee, hand and other joints that has been confirmed by radiographic findings with the use of KellgrenLawrence grading (i.e. grade 2, definite osteophyte(s) and joint space narrowing; or grades

3 - 4

, multiple moderate osteophytes, definite joint space narrowing with deformity and sclerosis) [11], and pain for at least 1 month over the past 12 months. Disability weights ranging from 0 (full health) to 1 (death) were used to indicate the degree of health loss associated with osteoarthritis. Disability weights in the GBD 2021 study were generated from data collected from open-access web-based surveys [8-10]. YLDs for osteoarthritis were calculated by multiplying the prevalence of each sequela category by the corresponding disability weight.
The SDI is a composite indicator of a lagging distribution of per capita income (i.e., gross domestic product per capita smoothed over the previous 10 years), the average years of schooling of the population over 15 , and the total fertility rate under 25 . It ranges from 0 (less developed) to 1 (most developed). The data sources used for estimating the burden of osteoarthritis in the different countries and regions can be found in the GBD 2021 Data Input Sources Tool using the following link: https://vizhub.healthdata.org/gbd-results/ [12].

Data processing

While GBD 2021 reported all osteoarthritis data from 1990 to 2021, we applied the R programming language as a tool to make the graphs in order to present the prevalence, incidence and YLD of osteoarthritis, and to calculate the correlation coefficient of the age-standardised YLDs rate and SDI of regions, countries and territories. The number of living individuals with osteoarthritis and the age-standardised prevalence of osteoarthritis during the study period were reported with

95 %

uncertainty intervals (UIs).
R programming language was used to generate figures of estimates of crude and age-standardised prevalence, incidence and YLDs for the period 1990 to 2021, overall and separately by age, sex, and SDI. from data available from http://ghdx.healthdata.org/gbd-results/ [12].

Results

Global level

This study revealed that there were about 606.5 million (

95 %

UI 537.9 to 674.4 million) prevalent cases of osteoarthritis, with an age- standardised prevalence estimate of 6967.3 per

100, 000 (95 %

UI 6180.7 to 7686.1

)

. This was a

9.0 %

(

95 %

8.4 % - 9.5 %

) increase from 1990 to 2021 (Table 1). In addition, osteoarthritis accounted for approximately 46.6 million (

95 %

UI 41.0 to 52.0 million) incident cases globally with an age- standardised incidence rate of

535.0 (95 %

UI 472.4 to 592.0), an increase
Table 1 Prevalent cases, incident cases and years lived with disability (YLD) for osteoarthritis in 2021 for both sexes and percentage change of age- standardised rates by Global Burden of Disease regions

Prevalence(95% uncertainty interval)

Incidence(95% uncertainty interval)

YLDs(95% uncertainty interval)

Counts(2021)

Agestandardized rates

Percentage change in agestandardized rates between 1990 and 2021

Counts(2021)

Agestandardized rates

Percentage change in agestandardized rates between 1990 and 2021

Counts(2021)

Agestandardized rates

Percentage change in agestandardized rates between 1990 and 2021

Global

\begin{aligned} 606,989,319.0(537,873,607.7- \\ 670, 519, 617.3) \end{aligned}

\begin{aligned} 6967.3 (6180.7 - \\ 7686.1) \end{aligned}

9.0(8.4-9.5)

\begin{aligned} 46, 632, 144.4 (41, 122, 052.7 - \\ 51, 644, 430.8) \end{aligned}

\begin{aligned} 535.0(472.4- \\ 592.0) \end{aligned}

9.2(8.5-9.9)

\begin{aligned} 21, 304, 565.8 (10, 189, 161.5 - \\ 42, 935, 419.7) \end{aligned}

\begin{aligned} 244.5 (117.1 - \\ 493.1) \end{aligned}

9.7(9.1-10.4)

Southeast

Asia

\begin{aligned} 39, 227, 934.8 (34, 567, 606.8 - \\ 43, 609, 405.1) \end{aligned}

\begin{aligned} 5675.8 (5001.8 - \\ 6320.9) \end{aligned}

18.3(16.3-20.3)

\begin{aligned} 3, 261, 524.6 (2, 872, 404.6 - \\ 3, 641, 133.2) \end{aligned}

\begin{aligned} 437.1(386.1- \\ 485.0) \end{aligned}

16.2(14.5-18.1)

\begin{aligned} 1,357,627.8(645,150.3- \\ 2, 713, 214.4) \end{aligned}

\begin{aligned} 196.2(93.6- \\ 393.4) \end{aligned}

20.1(17.8-22.5)

Western Europe

\begin{aligned} 59,567,388.7(53,848,954.0- \\ 65960012.9) \end{aligned}

\begin{aligned} 7113.4(6407.1- \\ 7867.1) \end{aligned}

5.6(4.8-6.5)

\begin{aligned} 3, 918, 887.8 (3, 498, 381.8 - \\ 4, 363, 204.1) \end{aligned}

\begin{aligned} 557.7 (497.3 - \\ 618.5) \end{aligned}

6.9(6.0-8.1)

\begin{aligned} 2,131,317.2(1,038,439.6- \\ 4, 287, 322.7) \end{aligned}

\begin{aligned} 253.6 (123.1 - \\ 510.6) \end{aligned}

6.3(5.2-7.5)

East Asia

\begin{aligned} 158,285,423.7(139,469,182.9- \\ 176, 824, 968.2) \end{aligned}

\begin{aligned} 7036.1(6216.3- \\ 7835.8) \end{aligned}

14.3(12.1-16.4)

\begin{aligned} 12, 051, 700.5 (10, 562, 111.2 - \\ 13, 556, 244.2) \end{aligned}

\begin{aligned} 554.5 (486.9 - \\ 619.4) \end{aligned}

13.8(11.9-15.9)

\begin{aligned} 5, 518, 037.4 (2, 633, 493.7 - \\ 11, 061, 496.9) \end{aligned}

\begin{aligned} 245.0 (117.4 - \\ 492.4) \end{aligned}

16.1(13.8-18.6)

Eastern Europe

\begin{aligned} 27,107,907.9(23,769,327.2- \\ 30, 423, 620.2) \end{aligned}

\begin{aligned} 7906.1(6954.0- \\ 8880.1) \end{aligned}

4.8(3.7-5.9)

\begin{aligned} 1,833,037.9(1,612,584.0- \\ 2058220.0) \end{aligned}

\begin{aligned} 585.0 (515.2 - \\ 651.4) \end{aligned}

6.3(5.2-7.2)

\begin{aligned} 965, 580.3 (4, 665, 099.3 - \\ 1, 951, 745.0) \end{aligned}

\begin{aligned} 280.8 (134.4 - \\ 567.0) \end{aligned}

5.6(4.2-6.9)

Andean Latin America

\begin{aligned} 4,431,104.5(3,933,345.9- \\ 4, 885, 803.6) \end{aligned}

\begin{aligned} 7370.4(6552.1- \\ 8132.1) \end{aligned}

11.3(9.6-13.8)

363,396.5(319,747.6-402,547.1)

\begin{aligned} 578.2 (511.3 - \\ 641.1) \end{aligned}

11.3(8.9-13.7)

156,693.1(75,061.5-316,245.5)

\begin{aligned} 260.9 (125.2 - \\ 526.8) \end{aligned}

12.5(10.2-15.0)

Highincome Asia Pacific

\begin{aligned} 34, 625, 938.5 (31, 148, 249.6 - \\ 37, 978, 128.4) \end{aligned}

\begin{aligned} 8608.6 (7674.1 - \\ 9485.2) \end{aligned}

6.6(5.4-8.0)

\begin{aligned} 2,189,402.8(1,958,142.4- \\ 2, 413, 152.3) \end{aligned}

\begin{aligned} 682.1(606.1- \\ 752.8) \end{aligned}

6.4 (5.0-7.7)

\begin{aligned} 1,276,815.4(611,788.9- \\ 2, 579, 653.5) \end{aligned}

\begin{aligned} 315.0 (150.5 - \\ 636.8) \end{aligned}

8.2(6.7-9.8)

Central

Sub-

Saharan

Africa

\begin{aligned} 3, 517, 437.9 (3, 115, 894.4 - \\ 3, 914, 394.3) \end{aligned}

\begin{aligned} 5940.5(5268.3- \\ 6589.5) \end{aligned}

5.6(3.4-7.6)

339,701.2(298,430.9-378,042.5)

\begin{aligned} 463.1 (409.7 - \\ 515.2) \end{aligned}

4.8(2.4-7.2)

120,682.3(57,012.2-241,713.7)

\begin{aligned} 204.3(97.8- \\ 412.2) \end{aligned}

6.8(4.2-9.3)

South Asia

\begin{aligned} 96, 531, 168.7 (85, 576, 493.9 - \\ 106, 691, 000.6) \end{aligned}

\begin{aligned} 6323.1(5612.4- \\ 7009.6) \end{aligned}

17.0(15.3-18.7)

\begin{aligned} 8,220,377.7(7,241,991.2- \\ 9, 115, 916.3) \end{aligned}

\begin{aligned} 495.0 (436.6 - \\ 548.0) \end{aligned}

14.9(13.5-16.5)

\begin{aligned} 3, 311, 235.9 (1, 583, 933.9 - \\ 6, 656, 918.8) \end{aligned}

\begin{aligned} 216.9(104.0- \\ 438.0) \end{aligned}

19.2(17.3-21.3)

Southern Sub-

Saharan

Africa

\begin{aligned} 4, 289, 178.5 (3, 773, 086.3 - \\ 4, 755, 346.4) \end{aligned}

\begin{aligned} 7161.2 (6333.3 - \\ 7951.3) \end{aligned}

9.2(8.1-10.3)

375,227.7(330,227.1-417,302.2)

\begin{aligned} 557.2 (493.5 - \\ 618.2) \end{aligned}

8.6(7.3-9.7)

148,991.5(71,570.9-298,108.2)

\begin{aligned} 249.5 (120.4 - \\ 500.6) \end{aligned}

8.9(7.5-10.4)

Eastern

Sub-

Saharan

Africa

\begin{aligned} 10,409,572.2(9,265,845.8- \\ 11, 557, 319.1) \end{aligned}

\begin{aligned} 5830.0(5160.6- \\ 6476.6) \end{aligned}

14.0(11.9-15.9)

\begin{aligned} 1,000,971.0(885,083.8- \\ 1, 115, 451.2) \end{aligned}

\begin{aligned} 461.0(407.4- \\ 509.9) \end{aligned}

12.0(10.4-13.5)

358,151.0(171,683.7-719,704.2)

\begin{aligned} (201.0(96.1- \\ 405.3) \end{aligned}

15.8(13.6-18.0)

Central Europe

\begin{aligned} 14, 519, 446.4 (12, 794, 343.2 - \\ 16, 234, 191.0) \end{aligned}

\begin{aligned} 6948.5(6129.2- \\ 7752.7) \end{aligned}

10.7(9.6-11.8)

\begin{aligned} 960, 143.7 (849, 389.5 - \\ 1, 070, 329.0) \end{aligned}

\begin{aligned} 522.1 (460.8 - \\ 580.4) \end{aligned}

10.1(9.0-11.2)

514,447.1(248,116.7-1,044,283)

\begin{aligned} 245.4(117.6- \\ 496.2) \end{aligned}

12.2(10.9-13.6)

Oceania

508,189.0(451,273.1-565,164.8)

\begin{aligned} 6196.5 (5474.5 - \\ 6895.0) \end{aligned}

9.9(7.5-12.3)

47,742.6(41,835.0-53394.4)

\begin{aligned} 481.0 (423.1 - \\ 536.4) \end{aligned}

8.9(6.2-11.4)

17,457.2(8450.5-34,943.1)

\begin{aligned} 212.9(103.0- \\ 428.5) \end{aligned}

10.7(8.0-13.5)

Australasia

\begin{aligned} 3, 922, 513.7 (3, 537, 650.6 - \\ 4, 335, 715.1) \end{aligned}

\begin{aligned} 7917.6(7098.4- \\ 8735.7) \end{aligned}

10.0(7.6-12.9)

269,451.7(239,374.2-301,169.4)

\begin{aligned} 620.1 (550.8 - \\ 686.5) \end{aligned}

11.6(8.6-14.7)

140,906.1(69,471.5-286,856.0)

\begin{aligned} 283.4(139.2- \\ 578.0) \end{aligned}

11.4(8.0-14.6)

Prevalence(95% uncertainty interval) Incidence(95% uncertainty interval) YLDs(95% uncertainty interval) Counts(2021) Agestandardized rates Percentage change in agestandardized rates between 1990 and 2021 Counts(2021) Agestandardized rates Percentage change in agestandardized rates between 1990 and 2021 Counts(2021) Agestandardized rates Percentage change in agestandardized rates between 1990 and 2021 Global " 606,989,319.0(537,873,607.7- 670,519,617.3)" "6967.3(6180.7- 7686.1)" 9.0(8.4-9.5) "46,632,144.4(41,122,052.7- 51,644,430.8)" " 535.0(472.4- 592.0)" 9.2(8.5-9.9) "21,304,565.8(10,189,161.5- 42,935,419.7)" "244.5(117.1- 493.1)" 9.7(9.1-10.4) "Southeast Asia" "39,227,934.8(34,567,606.8- 43,609,405.1)" "5675.8(5001.8- 6320.9)" 18.3(16.3-20.3) "3,261,524.6(2,872,404.6- 3,641,133.2)" " 437.1(386.1- 485.0)" 16.2(14.5-18.1) " 1,357,627.8(645,150.3- 2,713,214.4)" " 196.2(93.6- 393.4)" 20.1(17.8-22.5) Western Europe " 59,567,388.7(53,848,954.0- 65960012.9)" " 7113.4(6407.1- 7867.1)" 5.6(4.8-6.5) "3,918,887.8(3,498,381.8- 4,363,204.1)" "557.7(497.3- 618.5)" 6.9(6.0-8.1) " 2,131,317.2(1,038,439.6- 4,287,322.7)" "253.6(123.1- 510.6)" 6.3(5.2-7.5) East Asia " 158,285,423.7(139,469,182.9- 176,824,968.2)" " 7036.1(6216.3- 7835.8)" 14.3(12.1-16.4) "12,051,700.5(10,562,111.2- 13,556,244.2)" "554.5(486.9- 619.4)" 13.8(11.9-15.9) "5,518,037.4(2,633,493.7- 11,061,496.9)" "245.0(117.4- 492.4)" 16.1(13.8-18.6) Eastern Europe " 27,107,907.9(23,769,327.2- 30,423,620.2)" " 7906.1(6954.0- 8880.1)" 4.8(3.7-5.9) " 1,833,037.9(1,612,584.0- 2058220.0) " "585.0(515.2- 651.4)" 6.3(5.2-7.2) "965,580.3(4,665,099.3- 1,951,745.0)" "280.8(134.4- 567.0)" 5.6(4.2-6.9) Andean Latin America " 4,431,104.5(3,933,345.9- 4,885,803.6)" " 7370.4(6552.1- 8132.1)" 11.3(9.6-13.8) 363,396.5(319,747.6-402,547.1) "578.2(511.3- 641.1)" 11.3(8.9-13.7) 156,693.1(75,061.5-316,245.5) "260.9(125.2- 526.8)" 12.5(10.2-15.0) Highincome Asia Pacific "34,625,938.5(31,148,249.6- 37,978,128.4)" "8608.6(7674.1- 9485.2)" 6.6(5.4-8.0) " 2,189,402.8(1,958,142.4- 2,413,152.3)" " 682.1(606.1- 752.8)" 6.4 (5.0-7.7) " 1,276,815.4(611,788.9- 2,579,653.5)" "315.0(150.5- 636.8)" 8.2(6.7-9.8) "Central Sub- Saharan Africa" "3,517,437.9(3,115,894.4- 3,914,394.3)" " 5940.5(5268.3- 6589.5)" 5.6(3.4-7.6) 339,701.2(298,430.9-378,042.5) "463.1(409.7- 515.2)" 4.8(2.4-7.2) 120,682.3(57,012.2-241,713.7) " 204.3(97.8- 412.2)" 6.8(4.2-9.3) South Asia "96,531,168.7(85,576,493.9- 106,691,000.6)" " 6323.1(5612.4- 7009.6)" 17.0(15.3-18.7) " 8,220,377.7(7,241,991.2- 9,115,916.3)" "495.0(436.6- 548.0)" 14.9(13.5-16.5) "3,311,235.9(1,583,933.9- 6,656,918.8)" " 216.9(104.0- 438.0)" 19.2(17.3-21.3) "Southern Sub- Saharan Africa" "4,289,178.5(3,773,086.3- 4,755,346.4)" "7161.2(6333.3- 7951.3)" 9.2(8.1-10.3) 375,227.7(330,227.1-417,302.2) "557.2(493.5- 618.2)" 8.6(7.3-9.7) 148,991.5(71,570.9-298,108.2) "249.5(120.4- 500.6)" 8.9(7.5-10.4) "Eastern Sub- Saharan Africa" " 10,409,572.2(9,265,845.8- 11,557,319.1)" " 5830.0(5160.6- 6476.6)" 14.0(11.9-15.9) " 1,000,971.0(885,083.8- 1,115,451.2)" " 461.0(407.4- 509.9)" 12.0(10.4-13.5) 358,151.0(171,683.7-719,704.2) " (201.0(96.1- 405.3)" 15.8(13.6-18.0) Central Europe "14,519,446.4(12,794,343.2- 16,234,191.0)" " 6948.5(6129.2- 7752.7)" 10.7(9.6-11.8) "960,143.7(849,389.5- 1,070,329.0)" "522.1(460.8- 580.4)" 10.1(9.0-11.2) 514,447.1(248,116.7-1,044,283) " 245.4(117.6- 496.2)" 12.2(10.9-13.6) Oceania 508,189.0(451,273.1-565,164.8) "6196.5(5474.5- 6895.0)" 9.9(7.5-12.3) 47,742.6(41,835.0-53394.4) "481.0(423.1- 536.4)" 8.9(6.2-11.4) 17,457.2(8450.5-34,943.1) " 212.9(103.0- 428.5)" 10.7(8.0-13.5) Australasia "3,922,513.7(3,537,650.6- 4,335,715.1)" " 7917.6(7098.4- 8735.7)" 10.0(7.6-12.9) 269,451.7(239,374.2-301,169.4) "620.1(550.8- 686.5)" 11.6(8.6-14.7) 140,906.1(69,471.5-286,856.0) " 283.4(139.2- 578.0)" 11.4(8.0-14.6)

| | Prevalence(95% uncertainty interval) | | | Incidence(95% uncertainty interval) | | | YLDs(95% uncertainty interval) | | | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | | Counts(2021) | Agestandardized rates | Percentage change in agestandardized rates between 1990 and 2021 | Counts(2021) | Agestandardized rates | Percentage change in agestandardized rates between 1990 and 2021 | Counts(2021) | Agestandardized rates | Percentage change in agestandardized rates between 1990 and 2021 | | Global | $\begin{aligned} & \text { 606,989,319.0(537,873,607.7- } \\ & 670,519,617.3) \end{aligned}$ | $\begin{aligned} & 6967.3(6180.7- \\ & 7686.1) \end{aligned}$ | 9.0(8.4-9.5) | $\begin{aligned} & 46,632,144.4(41,122,052.7- \\ & 51,644,430.8) \end{aligned}$ | $\begin{aligned} & \text { 535.0(472.4- } \\ & 592.0) \end{aligned}$ | 9.2(8.5-9.9) | $\begin{aligned} & 21,304,565.8(10,189,161.5- \\ & 42,935,419.7) \end{aligned}$ | $\begin{aligned} & 244.5(117.1- \\ & 493.1) \end{aligned}$ | 9.7(9.1-10.4) | | Southeast Asia | $\begin{aligned} & 39,227,934.8(34,567,606.8- \\ & 43,609,405.1) \end{aligned}$ | $\begin{aligned} & 5675.8(5001.8- \\ & 6320.9) \end{aligned}$ | 18.3(16.3-20.3) | $\begin{aligned} & 3,261,524.6(2,872,404.6- \\ & 3,641,133.2) \end{aligned}$ | $\begin{aligned} & \text { 437.1(386.1- } \\ & 485.0) \end{aligned}$ | 16.2(14.5-18.1) | $\begin{aligned} & \text { 1,357,627.8(645,150.3- } \\ & 2,713,214.4) \end{aligned}$ | $\begin{aligned} & \text { 196.2(93.6- } \\ & 393.4) \end{aligned}$ | 20.1(17.8-22.5) | | Western Europe | $\begin{aligned} & \text { 59,567,388.7(53,848,954.0- } \\ & 65960012.9) \end{aligned}$ | $\begin{aligned} & \text { 7113.4(6407.1- } \\ & 7867.1) \end{aligned}$ | 5.6(4.8-6.5) | $\begin{aligned} & 3,918,887.8(3,498,381.8- \\ & 4,363,204.1) \end{aligned}$ | $\begin{aligned} & 557.7(497.3- \\ & 618.5) \end{aligned}$ | 6.9(6.0-8.1) | $\begin{aligned} & \text { 2,131,317.2(1,038,439.6- } \\ & 4,287,322.7) \end{aligned}$ | $\begin{aligned} & 253.6(123.1- \\ & 510.6) \end{aligned}$ | 6.3(5.2-7.5) | | East Asia | $\begin{aligned} & \text { 158,285,423.7(139,469,182.9- } \\ & 176,824,968.2) \end{aligned}$ | $\begin{aligned} & \text { 7036.1(6216.3- } \\ & 7835.8) \end{aligned}$ | 14.3(12.1-16.4) | $\begin{aligned} & 12,051,700.5(10,562,111.2- \\ & 13,556,244.2) \end{aligned}$ | $\begin{aligned} & 554.5(486.9- \\ & 619.4) \end{aligned}$ | 13.8(11.9-15.9) | $\begin{aligned} & 5,518,037.4(2,633,493.7- \\ & 11,061,496.9) \end{aligned}$ | $\begin{aligned} & 245.0(117.4- \\ & 492.4) \end{aligned}$ | 16.1(13.8-18.6) | | Eastern Europe | $\begin{aligned} & \text { 27,107,907.9(23,769,327.2- } \\ & 30,423,620.2) \end{aligned}$ | $\begin{aligned} & \text { 7906.1(6954.0- } \\ & 8880.1) \end{aligned}$ | 4.8(3.7-5.9) | $\begin{aligned} & \text { 1,833,037.9(1,612,584.0- } \\ & \text { 2058220.0) } \end{aligned}$ | $\begin{aligned} & 585.0(515.2- \\ & 651.4) \end{aligned}$ | 6.3(5.2-7.2) | $\begin{aligned} & 965,580.3(4,665,099.3- \\ & 1,951,745.0) \end{aligned}$ | $\begin{aligned} & 280.8(134.4- \\ & 567.0) \end{aligned}$ | 5.6(4.2-6.9) | | Andean Latin America | $\begin{aligned} & \text { 4,431,104.5(3,933,345.9- } \\ & 4,885,803.6) \end{aligned}$ | $\begin{aligned} & \text { 7370.4(6552.1- } \\ & 8132.1) \end{aligned}$ | 11.3(9.6-13.8) | 363,396.5(319,747.6-402,547.1) | $\begin{aligned} & 578.2(511.3- \\ & 641.1) \end{aligned}$ | 11.3(8.9-13.7) | 156,693.1(75,061.5-316,245.5) | $\begin{aligned} & 260.9(125.2- \\ & 526.8) \end{aligned}$ | 12.5(10.2-15.0) | | Highincome Asia Pacific | $\begin{aligned} & 34,625,938.5(31,148,249.6- \\ & 37,978,128.4) \end{aligned}$ | $\begin{aligned} & 8608.6(7674.1- \\ & 9485.2) \end{aligned}$ | 6.6(5.4-8.0) | $\begin{aligned} & \text { 2,189,402.8(1,958,142.4- } \\ & 2,413,152.3) \end{aligned}$ | $\begin{aligned} & \text { 682.1(606.1- } \\ & 752.8) \end{aligned}$ | 6.4 (5.0-7.7) | $\begin{aligned} & \text { 1,276,815.4(611,788.9- } \\ & 2,579,653.5) \end{aligned}$ | $\begin{aligned} & 315.0(150.5- \\ & 636.8) \end{aligned}$ | 8.2(6.7-9.8) | | Central Sub- Saharan Africa | $\begin{aligned} & 3,517,437.9(3,115,894.4- \\ & 3,914,394.3) \end{aligned}$ | $\begin{aligned} & \text { 5940.5(5268.3- } \\ & 6589.5) \end{aligned}$ | 5.6(3.4-7.6) | 339,701.2(298,430.9-378,042.5) | $\begin{aligned} & 463.1(409.7- \\ & 515.2) \end{aligned}$ | 4.8(2.4-7.2) | 120,682.3(57,012.2-241,713.7) | $\begin{aligned} & \text { 204.3(97.8- } \\ & 412.2) \end{aligned}$ | 6.8(4.2-9.3) | | South Asia | $\begin{aligned} & 96,531,168.7(85,576,493.9- \\ & 106,691,000.6) \end{aligned}$ | $\begin{aligned} & \text { 6323.1(5612.4- } \\ & 7009.6) \end{aligned}$ | 17.0(15.3-18.7) | $\begin{aligned} & \text { 8,220,377.7(7,241,991.2- } \\ & 9,115,916.3) \end{aligned}$ | $\begin{aligned} & 495.0(436.6- \\ & 548.0) \end{aligned}$ | 14.9(13.5-16.5) | $\begin{aligned} & 3,311,235.9(1,583,933.9- \\ & 6,656,918.8) \end{aligned}$ | $\begin{aligned} & \text { 216.9(104.0- } \\ & 438.0) \end{aligned}$ | 19.2(17.3-21.3) | | Southern Sub- Saharan Africa | $\begin{aligned} & 4,289,178.5(3,773,086.3- \\ & 4,755,346.4) \end{aligned}$ | $\begin{aligned} & 7161.2(6333.3- \\ & 7951.3) \end{aligned}$ | 9.2(8.1-10.3) | 375,227.7(330,227.1-417,302.2) | $\begin{aligned} & 557.2(493.5- \\ & 618.2) \end{aligned}$ | 8.6(7.3-9.7) | 148,991.5(71,570.9-298,108.2) | $\begin{aligned} & 249.5(120.4- \\ & 500.6) \end{aligned}$ | 8.9(7.5-10.4) | | Eastern Sub- Saharan Africa | $\begin{aligned} & \text { 10,409,572.2(9,265,845.8- } \\ & 11,557,319.1) \end{aligned}$ | $\begin{aligned} & \text { 5830.0(5160.6- } \\ & 6476.6) \end{aligned}$ | 14.0(11.9-15.9) | $\begin{aligned} & \text { 1,000,971.0(885,083.8- } \\ & 1,115,451.2) \end{aligned}$ | $\begin{aligned} & \text { 461.0(407.4- } \\ & 509.9) \end{aligned}$ | 12.0(10.4-13.5) | 358,151.0(171,683.7-719,704.2) | $\begin{aligned} & \text { (201.0(96.1- } \\ & 405.3) \end{aligned}$ | 15.8(13.6-18.0) | | Central Europe | $\begin{aligned} & 14,519,446.4(12,794,343.2- \\ & 16,234,191.0) \end{aligned}$ | $\begin{aligned} & \text { 6948.5(6129.2- } \\ & 7752.7) \end{aligned}$ | 10.7(9.6-11.8) | $\begin{aligned} & 960,143.7(849,389.5- \\ & 1,070,329.0) \end{aligned}$ | $\begin{aligned} & 522.1(460.8- \\ & 580.4) \end{aligned}$ | 10.1(9.0-11.2) | 514,447.1(248,116.7-1,044,283) | $\begin{aligned} & \text { 245.4(117.6- } \\ & 496.2) \end{aligned}$ | 12.2(10.9-13.6) | | Oceania | 508,189.0(451,273.1-565,164.8) | $\begin{aligned} & 6196.5(5474.5- \\ & 6895.0) \end{aligned}$ | 9.9(7.5-12.3) | 47,742.6(41,835.0-53394.4) | $\begin{aligned} & 481.0(423.1- \\ & 536.4) \end{aligned}$ | 8.9(6.2-11.4) | 17,457.2(8450.5-34,943.1) | $\begin{aligned} & \text { 212.9(103.0- } \\ & 428.5) \end{aligned}$ | 10.7(8.0-13.5) | | Australasia | $\begin{aligned} & 3,922,513.7(3,537,650.6- \\ & 4,335,715.1) \end{aligned}$ | $\begin{aligned} & \text { 7917.6(7098.4- } \\ & 8735.7) \end{aligned}$ | 10.0(7.6-12.9) | 269,451.7(239,374.2-301,169.4) | $\begin{aligned} & 620.1(550.8- \\ & 686.5) \end{aligned}$ | 11.6(8.6-14.7) | 140,906.1(69,471.5-286,856.0) | $\begin{aligned} & \text { 283.4(139.2- } \\ & 578.0) \end{aligned}$ | 11.4(8.0-14.6) |

*Correspondence:
Gaoxiang Xu
xugx301@163.com
Jianfeng He
hejf301@163.com
Full list of author information is available at the end of the article

Global, regional and national burden of osteoarthritis in 1990-2021: a systematic analysis of the global burden of disease study 2021 1990-2021 年全球、区域和国家骨关节炎负担：2021 年全球疾病负担研究的系统分析

Abstract 抽象

Introduction 介绍

Methods 方法

Data source 数据源

Data processing

Results

Global level

Global, regional and national burden of osteoarthritis in 1990-2021: a systematic analysis of the global burden of disease study 2021
1990-2021 年全球、区域和国家骨关节炎负担：2021 年全球疾病负担研究的系统分析