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Health Coverage and Its Relation to the Prevalence and Intensity of Symptomatic Knee Osteoarthritis
  1. Jacob Clearfield, MD,
  2. Neil A. Segal, MD, MS
  1. From the University of Iowa, Iowa City, IA.
  1. Received July 30, 2010, and in revised form May 16, 2011.
  2. Accepted for publication May 16, 2011.
  3. Reprints: Neil A. Segal, MD, MS, Departments of Orthopaedics and Rehabilitation, Radiology and Epidemiology, The University of Iowa, 200 Hawkins Dr, 0728 JPP, Iowa City, IA 52242-1088. E-mail: segal-research{at}
  4. This research was supported by the National Institutes of Health Short-term Training for Students in Health Professions (T35 HL007485-30 to J.C.) and a Beeson Career Development Award (K23AG030945 to N.S.). The OAI is a public-private partnership composed of 5 contracts (N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262) funded by the National Institutes of Health. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health.


Objective This study aimed to determine whether health coverage among older adults is associated with (1) the prevalence of symptomatic knee osteoarthritis (OA) and (2) disablement in those with symptomatic knee OA.

Methods Data were collected from the Osteoarthritis Initiative data set 5.2.1, a cohort study of subjects with or at risk for knee OA. Prevalence of symptomatic knee OA (knee symptoms on most of the last 30 days and Kellgren-Lawrence grade >2 on knee radiograph) was compared between those with and without health coverage among subjects aged 45 to 65 years, adjusted for age and body mass index. For those with symptomatic knee OA, Physical Activity for the Elderly scores and Knee Osteoarthritis Outcomes Survey function, pain, and quality-of-life scores were compared between those with and without health coverage before and after adjustment for age and body mass index.

Results Among subjects with health coverage, 27.8% had symptomatic knee OA compared with 36.1% of those without health coverage (P = 0.0204 before and P > 0.24 after adjustment). Among subjects with symptomatic knee OA with and without health coverage physical activity differed significantly (P = 0.048), as did pain (P < 0.0001), function (P = 0.0001), and quality of life (P < 0.0001).

Conclusions Lack of health coverage was not associated with the prevalence of symptomatic knee OA after adjustment. However, those with symptomatic knee OA without health coverage reported reduced physical activity, greater pain, worse functional limitations, and decreased quality of life.

Key Words
  • knee osteoarthritis
  • health coverage
  • health insurance
  • knee osteoarthritis prevalence

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