Prevalence Survey On Symptomatic OA In Rural Areas Of Shanxi Province And Analysis Of Factors Affecting Clinical Efficacy Of OA

Objective①To investigate the prevalence of symptomatic osteoarthritis in rural areas of Shanxi Province and discuss the factors affecting the occurrence of osteoarthritis;②To study the method which meets multiple constraint conditions and improves the sample structure and the nonlinear calibration weighting algorithm, and verify the practical value of the nonlinear calibration weighting algorithm in the epidemiological survey data of osteoarthritis and others;③To study the mixed effect model and its effect in short-term efficacy evaluation of symptomatic osteoarthritis and investigate the factors affecting the short-term efficacy of symptomatic osteoarthritis;④To study the effect of gamma frailty model in the long-term efficacy of repeatedly hospitalized patients with knee osteoarthritis and discuss the factors affecting the long-term efficacy, prognosis and disease progression of symptomatic osteoarthritis.Methods①Towns and villages were selected from Yangcheng County and Pianguan County of Shanxi Province by multistage stratified cluster sampling. In the selected villages, the general survey was conducted for the residents over16-years-old who signed the Informed Consent Form according to Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) of the World Health Organization (WHO). Rheumatologists examined patients with symptoms. Suspected patients had X-ray examination for the corresponding parts within10days.2radiologists read the X-ray film independently and3rheumatologists made the diagnosis according to the examination results. Possible risk factors for symptomatic osteoarthritis were analyzed. Chi-square test was adopted for univariate analysis and Logistic regression analysis was adopted for multivariate screening;②In the epidemiological survey of osteoarthritis, the survey samples were expected to be the most representative of the population. The high-dimensional and complex data met multiple constraint conditions when weighed to improve the sample structure. M code programming of MATLAB software was adopted to realize the program test of nonlinear calibration weighting, and the epidemiological survey data of osteoarthritis in Shanxi Province were adopted to verify the practicability and application prospect of the method;③Pain and symptom alleviation were still the most important clinical short-term objective. VAS was conducted for repeatedly hospitalized patients for several times in order to evaluate the short-term efficacy. Thus, the response variables of the obtained data were not independent but correlative. In this study, the mixed effect model was used to analyze the multiple VAS data of276patients treated by conventional western treatment and conventional treatment combined with acupuncture and discuss the factors affecting the short-term efficacy of symptomatic osteoarthritis;④As a special public risk model, the central theme of the frailty model was that different individuals in the event more or less had the specialty of easily experiencing this event, that was the frailty. The hospitalization times of repeatedly hospitalized patients with osteoarthritis were taken as the index for long-term efficacy evaluation in this study. The gamma frailty model was adopted to analyze the data of276repeatedly hospitalized patients with osteoarthritis and discuss the factors affecting the long-term efficacy (prognosis and disease progression) of symptomatic osteoarthritis.Results①7126permanent residents in the two counties were surveyed, of which1734patients had osteoarthritis with the prevalence of24.33%. The prevalence of knee osteoarthritis was the highest, about13.79%, followed by lumbar osteoarthritis (7.37%), cervical osteoarthritis (3.38%), hand osteoarthritis (3.27%), shoulder osteoarthritis (2.96%), elbow osteoarthritis (2.90%), ankle osteoarthritis (0.74%), hip osteoarthritis (0.59%), wrist osteoarthritis (0.48%), thoracic osteoarthritis (0.52%) and foot osteoarthritis (0.49%), respectively. The prevalence of knee osteoarthritis, ankle osteoarthritis, shoulder osteoarthritis and hand osteoarthritis between males and females had statistical difference (P<0.05). With osteoarthritis as the response variable, the variables with statistical significance in the univariate analysis were introduced into the logistic regression model. The variables were screened by forward selection and the inclusion criteria was set as0.05. The results indicated that age, sweet tooth, heating installation, marital status, occupation, education background, BMI and concomitant diseases were possible factors affecting the occurrence of osteoarthritis.②As the optimization method for the minimum under the given constraint conditions, the samples corrected by the nonlinear calibration weighting reflected the population structure better than the common weighting method. M code of matlab software realized arithmetic process easier and faster than C, FORTRAN and other programming languages. The error value generated by nonlinear calibration weighting was much smaller than that generated by common weighting, that was to say the correction on samples by nonlinear calibration weighting was much better than common才methods;③The mixed effects model allowed the correlation among data and heteroscedasticity. Thus, not only data mean value could be analyzed, but also variance and covariance could be modeled, providing modeling flexibility for the analysis of the repeated measurement data. In addition, the mixed effects model could better utilize the information contained in the data. The mixed effects model for VAS data of the repeatedly hospitalized patients with symptomatic osteoarthritis showed that regular conventional western treatment combined with acupuncture was better than pure western treatment on symptom and pain alleviation.④The analysis of repeatedly hospitalized patients with symptomatic osteoarthritis by gamma frailty model showed that the risk for repeated hospitalization of patients treated by conventional western treatment combined with acupuncture was obviously lower than that treated by pure western treatment; the risk for repeated hospitalization of males was obviously lower than that of females; the higher the BMI, the bigger the risk for repeated hospitalization; good health education compliance could obviously reduce the risk for repeated hospitalization; the higher the pain scores at last discharge, the bigger the risk for repeated hospitalization.Conclusion①The prevalence of symptomatic osteoarthritis in rural areas of Shanxi Province is not optimistic, involving many influence factors. Thus, the health administrative departments at each level and patients should pay much attention to symptomatic osteoarthritis.②Nonlinear calibration weighting can better improve the sample structure, with good application value in the epidemiological survey of symptomatic osteoarthritis and other surveys with known population distribution.③The use of mixed effects model in evaluating the short-term efficacy of repeatedly hospitalized patients with osteoarthritis can better utilize the information contained in the data for obtaining more reliable and detailed results than common univariate analysis. Thus, the mixed effects model has good application prospect in practical work. The regular treatment by the combination of Chinese and western medicine can obtain better short-term efficacy.④The use of frailty model in analyzing the data, of which the heterogeneity and dependence are unknown in advance can better solve the problems caused by unknown covariant. The use of gamma frailty model in evaluating long-term efficacy of osteoarthritis is more scientific. To the long-term efficacy and disease progression of the patients with osteoarthritis, the treatment by the combination of Chinese and western medicine, good health education compliance and normal weight can obviously reduce the hospitalization times and delay the disease progression.