Study To Find The Prevalence Of Knee Osteoarthritis In The ... · PDF fileOsteoarthritis In...

Study to Find the Prevalence of Knee

Osteoarthritis In the Indian Population and

Factors Associated with it

Study done by Prognosis Management & Research

Consultants Pvt. Ltd in Association with IOACON Agra

Study Period: Jun – Nov 2013

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Study Team

Principal Investigator

Dr Chandra Prakash Pal Head of Department

S. N. Medical College Agra (U.P), India

Prognosis Team

Dr. Abhijit Khanvilkar, Ms. Aruna Deshpande

Dr. Aditi Agashe Dr. Amol Mankar

Dr. Dhananjay Pathak

Concept & Vision:

Dr. Sanjay Chaturvedi, Organizing Secretary & IOACON 2013 Agra Team

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Table of Contents

Index List of Tables ............................................................................................................................... 5

List of Figures ............................................................................................................................ 10

Acknowledgements .................................................................................................................. 13

Chapter 1 Executive Summary .................................................................................................. 14

Chapter 2 Introduction.............................................................................................................. 15

2.1 Known Prevalence of Osteoarthritis ................................................................................ 16

2.2 Risk Factors of OA ........................................................................................................... 18

2.3 Need for prevention of OA .............................................................................................. 18

Chapter 3 Methodology ............................................................................................................ 19

3.1Objectives of study........................................................................................................ 19

3.2 Study Design ................................................................................................................... 19

3.3 Research instruments: ..................................................................................................... 21

3.4 Geographical areas of study ............................................................................................ 22

Ethical consideration ............................................................................................................. 23

Chapter 4 Findings .................................................................................................................... 26

4.1 Profile of sample ............................................................................................................. 26

4.3 Symptomatic Prevalence ................................................................................................. 44

4.4 PREVALENCE of OA by RADIOLOGICAL DIAGNOSIS .......................................................... 59

4.4 ASSOCIATED FACTORS ..................................................................................................... 63

4.5 Presence of Symptoms and OA ........................................................................................ 69

Chapter 5 Uttar Pradesh Analysis (Site – Agra) .......................................................................... 74

General Profile of Agra Population ................................................................................... 74

Total ........................................................................................................................................ 78

5.2 PREVALENCE OF SYMPTOMS ........................................................................................... 86

5.3 Prevalence of Knee OA by Radiological Diagnosis ............................................................ 89

OA Status ........................................................................................................................ 90

5.4 Associated Factors for OA................................................................................................ 91

Chapter 6 Maharashtra State Analysis (Site: Pune) .................................................................... 95

6.1 Prevalence by Symptoms............................................................................................... 107

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6.2 Prevalence of OA by Radiological Diagnosis ............................................................. 109

6.3 Associated Factors ................................................................................................... 111

Chapter 7 West Bengal State Findings ..................................................................................... 116

Site: Kolkata)........................................................................................................................... 116

6.1 Prevalence by Symptoms............................................................................................... 129

6.2 Prevalence of OA by Radiological Diagnosis ................................................................... 132

6.3 Associated factors for OA .............................................................................................. 134

Chapter 7 Karnataka State Analysis ......................................................................................... 139

(Site – Bangalore).................................................................................................................... 139

7.1 Prevalence of Symptoms ............................................................................................... 151

7.2 Prevalence of OA by Radiological Diagnosis ................................................................... 152

7.3 Associated factors for OA .............................................................................................. 155

Chapter 8 Uttarakhand State Analysis ..................................................................................... 159

(Site: Dehradun)...................................................................................................................... 159

8.1 Prevalence of Symptoms ............................................................................................... 171

8.2 Prevalence of Knee OA by Radiological Diagnosis .......................................................... 173

8.3 Associated factors in Dehradun ..................................................................................... 176

Chapter 9 Conclusion .............................................................................................................. 180

Chapter 10 Recommendations ................................................................................................ 182

References .............................................................................................................................. 182

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List of Tables

Table 1State-wise Distribution of study sample .................................................................. 26

Table 2 Site wise Distribution of study sample .................................................................... 27

Table 3 Site-wise distribution of each State......................................................................... 28

Table 4 Gender Distribution of total study sample .............................................................. 29

Table 5State-wise Gender Distribution of study sample ..................................................... 29

Table 6 Distribution of sample by age group ....................................................................... 31

Table 7 Education status of study sample ........................................................................... 32

Table 8 Occupational status of the sample .......................................................................... 33

Table 9 Diabetes and Hypertension status of Sample ........................................................ 34

Table 10Tobacco and Alcohol consumption ........................................................................ 34

Table 11 Type of Physical Activity ........................................................................................ 35

Table 12 Site wise distribution of Activity type..................................................................... 36

Table 13 Level of Physical Stress ........................................................................................ 37

Table 14Type of Toilet used by Participants........................................................................ 38

Table 15 Exercise status of participants .............................................................................. 39

Table 16 State wise distribution of participants with pain in knees in last 5 years and in

last 3 months .......................................................................................................................... 44

Table 17 Swelling in knee ..................................................................................................... 45

Table 18 Grinding sensation in Knee ..................................................................................... 46

Table 19 Clicking noise in knee ................................................................................................. 47

Table 20 Catch in knee .......................................................................................................... 48

Table 21 Frequency of Knee Pain .............................................................................................. 49

Table 22 Symptom of Knee Stiffness ......................................................................................... 50

Table 23 OA Status of Indian Population ............................................................................. 59

Table 24State-wise Prevalence of OA ................................................................................. 60

Table 25 Site-wise Distribution of Prevalence of OA for each state .................................. 62

Table 26 Gender and OA ...................................................................................................... 63

Table 27 BMI and OA ................................................................................................................ 64

Table 28 Prevalence of OA knees with Age ................................................................................ 65

Table 29 Association of Occupation and OA ............................................................................. 65

Table 30 Activity Level and OA ............................................................................................. 66

Table 31 Toilet type and OA ...................................................................................................... 67

Table 32 Exercise and OA prevalence ................................................................................. 68

Table 33 Pain and Stiffness in people with OA ................................................................... 69

Table 34 Frequency of symptoms in people with OA ......................................................... 70

Table 35Gender Distribution ................................................................................................. 74

Table 36 Site wise distribution of Participants ..................................................................... 75

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Table 37 Age distribution of Participants ............................................................................. 76

Table 38 Occupation distribution of Participants ................................................................. 77

Table 39 Educational status of Participants ......................................................................... 78

Table 40 Diabetes .................................................................................................................. 78

Table 41 Hypertension ........................................................................................................... 78

Table 42 Coronary Artery Disease ....................................................................................... 78

Table 43 Tobacco and Alcohol habits .................................................................................. 79

Table 44 Tobacco Pattern ..................................................................................................... 79

Table 45 Level of Physical activity ........................................................................................ 79

Table 46 Level of Physical Stress ......................................................................................... 80

Table 47Type of toilet used ................................................................................................... 85

Table 48 Exercise status ....................................................................................................... 85

Table 49 Participants who had pain in knee in the past 5 years ........................................ 86

Table 50 Participants who had pain in knees in the past 3 months ................................... 86

Table 51 Participants who had swelling in the knee ........................................................... 87

Table 52 Participants Who Had Grinding Sensation In The Knee ..................................... 87

Table 53 Participants who had clicking noise in knee ........................................................ 87

Table 54 Participants who had knee catch .......................................................................... 88

Table 55 Participants who experienced knee stiffness ....................................................... 88

Table 56 Gender wise prevalence of Knee OA ................................................................... 89

Table 57Site wise prevalence of OA .................................................................................... 90

Table 58 OA by Knee Involvement ....................................................................................... 90

Table 59 Gender and OA ...................................................................................................... 91

Table 60 OA and Age ............................................................................................................ 91

Table 61 BMI and OA ............................................................................................................ 92

Table 62 OA and Occupation status .................................................................................... 93

Table 63 OA and level of Physical Activity ........................................................................... 93

Table 64 Type of Toilet and OA ............................................................................................ 93

Table 65 Lifestyle factors and OA ......................................................................................... 94

Table 66 Distribution of sample size by gender .................................................................. 95

Table 67 Site-wise distribution of sample of Pune .............................................................. 96

Table 68 Distribution of Sample By age group .................................................................... 97

Table 69 Occupation status of population of Pune ............................................................. 98

Table 70 Educational status of Pune population ................................................................. 99

Table 71 People with Diabetes ............................................................................................. 99

Table 72 People with Hypertension ...................................................................................... 99

Table 73 People with CAD .................................................................................................. 100

Table 74 Tobacco Users .................................................................................................... 100

Table 75 Pattern of tobacco users ...................................................................................... 100

Table 76 Alcohol consumption status of population .......................................................... 101

Table 77 Type of Physical Activity ...................................................................................... 101

Table 78 Physical stress Level ........................................................................................... 102

Table 79 Type of Toilet use ................................................................................................. 106

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Table 80 Exercise ................................................................................................................ 106

Table 81 Pain in knees anytime in the last 5 years ........................................................... 107

Table 82 Pain in knees anytime in the last 3 months........................................................ 107

Table 83 Swelling of Knee joint........................................................................................... 108

Table 84 Grinding Pain of Knee joint .................................................................................. 108

Table 85 Clicking Pain of Knee joint ................................................................................... 108

Table 86 Knee catch while moving ..................................................................................... 108

Table 87 Stiffness in Knee Joint ......................................................................................... 109

Table 88 Prevalence of OA in Pune ................................................................................... 109

Table 89 Prevalence of OA by Gender .............................................................................. 110

Table 90 Site-wise Prevalence of OA................................................................................. 110

Table 91 Prevalence of OA by Knee Involvement ............................................................ 110

Table 92 Association of Gender and OA ........................................................................... 111

Table 93 Association of Age and OA ................................................................................. 111

Table 94 Association of OA and BMI ................................................................................. 112

Table 95 Association of OA and Physical activity level in Pune ...................................... 113

Table 96 Association of OA and toilet type in Pune .......................................................... 113

Table 97 Association of OA and Exercise in Pune............................................................ 114

Table 98 Association of OA and Tobacco Use in Pune .................................................... 114

Table 99 Association of OA and smoking in Pune ............................................................ 114

Table 100 Association of OA and Alcohol in Pune............................................................ 115

Table 101 Gender Distribution of population Of Kolkata .................................................. 116

Table 102 Site-wise Distribution of Population .................................................................. 117

Table 103 Distribution of population by Age group ........................................................... 118

Table 104 Occupational status of population .................................................................... 119

Table 105 Educational status of population ....................................................................... 120

Table 106 Diabetic status of sample in Kolkata ................................................................ 120

Table 107 Hypertension Status of sample in Kolkata ....................................................... 121

Table 108 CAD Status of sample in Kolkata...................................................................... 121

Table 109 Tobacco Use of sample in Kolkata ................................................................... 121

Table 110 Tobacco use pattern in Kolkata sample ........................................................... 122

Table 111 Alcohol consumption of Kolkata sample .......................................................... 122

Table 112 Type of activity of Kolkata sample .................................................................... 122

Table 113 Physical stress level of Kolkata sample ........................................................... 123

Table 114 Type of Toilet Used in Kolkata .......................................................................... 128

Table 115 Exercise status of Kolkata sample .................................................................... 129

Table 116 Knee pain status in last 5 years of Kolkata sample ........................................ 129

Table 117 Knee pain status in last 3 months of Kolkata sample ..................................... 129

Table 118 Swelling over knee joint in Kolkata sample ...................................................... 130

Table 119 Grinding pain in knee in Kolkata sample .......................................................... 130

Table 120 Clicking pain in knee in Kolkata sample ........................................................... 131

Table 121 Catch up pain in knee in Kolkata sample ......................................................... 131

Table 122 stiffness in knee joint in Kolkata sample .......................................................... 131

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Table 123 Prevalence of OA in Kolkata .............................................................................. 132

Table 124 Prevalence of OA by gender ............................................................................. 133

Table 125 Site-wise Prevalence of OA .............................................................................. 133

Table 126 OA by Knee Involvement in Kolkata ................................................................. 134

Table 127 Association of OA and Gender in Kolkata........................................................ 134

Table 128 Association of OA and Age ............................................................................... 134

Table 129 Association of OA and BMI ............................................................................... 135

Table 130 Association of OA and Physical activity level .................................................. 136

Table 131 Association of OA and toilet type ...................................................................... 136

Table 132 Association of OA and Exercise ....................................................................... 137

Table 133 Association of OA and Tobacco ....................................................................... 137

Table 134 Association of OA and Smoking ....................................................................... 137

Table 135 Association of OA and Alcohol.......................................................................... 138

Table 136 Distribution of sample by Gender in Bangalore ............................................... 139

Table 137 Site-wise Distribution of Population in Bangalore ............................................ 139

Table 138 Distribution of population by Age group ........................................................... 140

Table 139 Occupational status of population in Bangalore .............................................. 141

Table 140 Educational status of population ...................................................................... 142

Table 141 People with diabetes .......................................................................................... 143

Table 142 people with hypertension ................................................................................... 143

Table 143 people with coronary artery disease ................................................................. 144

Table 144 Tobacco Use in Bangalore ................................................................................ 144

Table 145 Tobacco Use pattern in Bangalore ................................................................... 144

Table 146 Alcohol status of population .............................................................................. 145

Table 147 Physical activity of population ........................................................................... 145

Table 148 Physical stress level of population .................................................................... 145

Table 149 Type of toilet use by population ........................................................................ 146

Table 150 Exercise status of population ............................................................................ 146

Table 151 Knee pain status in last 5 years ........................................................................ 151

Table 152 Knee pain status in last 3 months ..................................................................... 151

Table 153 Swelling of knee joint ......................................................................................... 152

Table 154 Prevalence of OA in Bangalore ........................................................................ 152


Table 156 Site wise prevalence of OA ............................................................................... 154

Table 157 Prevalence of OA by knee Involvement ........................................................... 155

Table 158 Prevalence of OA By gender............................................................................. 155

Table 159 Association of OA with age category................................................................ 155

Table 160 Association of BMI with OA ............................................................................... 156

Table 161 Association of occupation with OA ................................................................... 156

Table 162 Association of physical activity with OA ........................................................... 156

Table 163 Association of type of Toilet use with OA......................................................... 157

Table 164 Association of exercise with OA ....................................................................... 157

Table 165 Association of type of Tobacco use with OA ................................................... 157

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Table 166 Association of smoking use with OA ................................................................ 158

Table 167 Association of Alcohol consumption with OA ................................................... 158

Table 168 Distribution of population by gender ................................................................. 159

Table 169 Site –wise distribution of sample ...................................................................... 160

Table 170 Distribution of sample by age group ................................................................. 161

Table 171 Occupation status of population ....................................................................... 162

Table 172 Educational status of population ....................................................................... 163

Table 173 Diabetic status of Population............................................................................. 163

Table 174 Hypertension Status........................................................................................... 163

Table 175 Coronary Artery Disease ................................................................................... 164

Table 176 Tobacco Users ................................................................................................... 164

Table 177 Tobacco use pattern .......................................................................................... 164

Table 178 Alcohol status ..................................................................................................... 164

Table 179 Type of physical activity ..................................................................................... 165

Table 180 Level of physical stress ..................................................................................... 165

Table 181 Type of toilet use ................................................................................................ 170

Table 182 Exercise status ................................................................................................... 170

Table 183 Knee pain status in last 5 years ........................................................................ 171

Table 184 Knee pain status in last 3 months ..................................................................... 171

Table 185 swelling of knee joint .......................................................................................... 171

Table 186 Grinding pain In knee joint................................................................................. 172

Table 187 clicking pain in knee ........................................................................................... 172

Table 188 catch pain in knee .............................................................................................. 172

Table 189 stiffness in knee joint ......................................................................................... 173

Table 190 Prevalence of OA in Dehradun ......................................................................... 173


Table 192 site-wise prevalence of OA ............................................................................... 174

Table 193 Prevalence by knee joint involvement ............................................................. 175

Table 194 Association of gender and OA .......................................................................... 176

Table 195 Association of Age and OA ............................................................................... 176

Table 196 Association of BMI and OA ............................................................................... 177

Table 197 Association of OA and Occupation ................................................................... 177

Table 198 Association of OA and Physical activity level .................................................. 178

Table 199 Association of OA knees and Toilet Type in Dehradun .................................. 179

Table 200 Association of OA and Exercise in Dehradun.................................................. 179

Table 201Association of OA and Tobacco habits in Dehradun ....................................... 179

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List of Figures

Figure 1 State-wise Distribution of study sample (%) ........................................................ 26

Figure 2 Site wise distribution of full sample........................................................................ 27

Figure 3 Distribution of sample covered............................................................................... 28

Figure 4: State wise gender distribution ............................................................................... 30

Figure 5 Age Distribution of Sample (%) .............................................................................. 31

Figure 6 Education status of the sample (%) ....................................................................... 32

Figure 7 Employment status of sample (%) ......................................................................... 33

Figure 8 Diabetes and Hypertension of sample (%) ........................................................... 34

Figure 9 Tobacco and Alcohol habits of the sample (%) .................................................... 35

Figure 10 Type of Physical activity (%) ............................................................................... 35

Figure 11 State wise distribution of Physical activity level ................................................. 36

Figure 12: Level of Physical stress of participants .............................................................. 37

Figure 13 Type of toilet used by the participants (%).......................................................... 38

Figure 14 Participants who exercise (%) ............................................................................. 39

Figure 15 Pain symptoms of Participants ............................................................................ 44

Figure 16: Swelling in knee (%) ............................................................................................ 45

Figure 17: Grinding sensation in Knees (%) ................................................................................ 46

Figure 18 Clicking noise in knees (%) ......................................................................................... 47

Figure 19 Clicking noise in Knees ............................................................................................... 48

Figure 20 Frequency of knee pain ....................................................................................... 49

Figure 21: Stiffness in Knee (%) ........................................................................................... 50

Figure 22: OA prevalence (%) .............................................................................................. 60

Figure 23 State wise Prevalence of OA (%) ........................................................................ 61

Figure 24 Site wise distribution of OA for full sample (%) .................................................. 61

Figure 25 Site wise prevalence of OA in each state ........................................................... 62

Figure 26 Gender difference in OA prevalence ................................................................... 63

Figure 27 Prevalence of OA according to BMI ............................................................................ 64

Figure 28: Association of Age and Knee OA ....................................................................... 65

Figure 29 Prevalence According to Occupation ....................... Error! Bookmark not defined.

Figure 30 Physical activity level and OA prevalence (%) ............................................................. 66

Figure 31 Toilet type used and OA (%) ................................................................................ 67

Figure 32 : Exercise level and OA ........................................................................................ 68

Figure 33: OA prevalence in participants with pain and stiffness symptoms .............................. 69

Figure 34 Frequency of symptoms in participants with OA (%) ......................................... 70

Figure 35 Gender distribution (%) ....................................................................................... 74

Figure 36 Site wise distribution of participants(%) .............................................................. 75

Figure 37 Age distribution of Participants ............................................................................ 76

Figure 38 Occupation distribution of Participants ................................................................ 77

Figure 39: Physical activity level (%) .................................................................................... 80

Figure 40 Pain in Last 5 Years and Pain in last 3 Months (%) ........................................... 86

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Figure 41 Prevalence in Agra (%) ....................................................................................... 89

Figure 42: Site wise prevalence in Agra............................................................................... 90

Figure 43: Association of OA and Gender in Agra (%) ....................................................... 91

Figure 44: Association of Age and OA in Agra .................................................................... 92

Figure 45: Association on BMI and OA ................................................................................ 92

Figure 46: Type of Toilet and OA.......................................................................................... 94

Figure 47 Gender distribution in Pune ................................................................................. 95

Figure 48 Site wise distribution of sample in Pune ............................................................. 96

Figure 49 Age-wise sample distribution in Pune ................................................................. 97

Figure 50 Occupation wise distribution of sample in Pune ................................................. 98

Figure 51 Distribution of Physical Activity level in Pune ................................................... 101

Figure 52 Pain in the last 5 years and Pain in last 3 months in Pune sample ................ 107

Figure 53: OA prevalence in Pune ..................................................................................... 109

Figure 54 Site wise distribution of Prevalence in Pune Sample ...................................... 110

Figure 55: Association of Age and OA in Pune ................................................................. 111

Figure 56: Association of OA and BMI (%) ........................................................................ 112

Figure 57: Association on OA and Occupation and OA in Pune ..................................... 113

Figure 58: Gender distribution in Kolkata sample ............................................................. 116

Figure 59 Site wise distribution of Kolkata sample (%)..................................................... 117

Figure 60 Age distribution of Kolkata sample (%) ............................................................. 118

Figure 61 Occupation distribution of sample in Kolkata ................................................... 119

Figure 62 Physical activity level of Kolkata sample .......................................................... 123

Figure 63 Prevalence of OA in Kolkata .............................................................................. 132

Figure 64: Site wise OA prevalence in Kolkata ................................................................. 133

Figure 65: Association of BMI and OA in Kolkata ............................................................. 135

Figure 66 Gender Distribution of Sample in Bangalore .................................................... 139

Figure 67 Site wise distribution of sample in Bangalore ................................................... 140

Figure 68 Distribution of population by Age group ............................................................ 141

Figure 69 Occupational status of population ..................................................................... 142

Figure 70 Educational status of population ........................................................................ 143

Figure 71: Knee OA prevalence in Bangalore ................................................................... 153

Figure 72 Prevalence of OA by gender .............................................................................. 154

Figure 73 Site wise prevalence of OA ................................................................................ 154

Figure 74 Gender Distribution in Dehradun Sample ......................................................... 159

Figure 75 Site wise Distribution in Dehradun .................................................................... 160

Figure 76 Age Distribution in Dehradun ............................................................................. 161

Figure 77 Occupation Distribution in Dehradun ................................................................ 162

Figure 78 Prevalence of Knee OA in Dehradun ................................................................ 173

Figure 79 Site wise Prevalence of OA knees in Dehradun (%) ....................................... 174

Figure 80 Association of Age and OA Knees in Dehradun .............................................. 176

Figure 81: Association of Occupation and OA in Dehradun ............................................. 178

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Acknowledgements

We would firstly like to thank all the members of IOACON, Agra for

entrusting the responsibility of implementing this study at multiple sites of

India.

Prognosis would like to acknowledge the contribution by all the members

in this study from time to time, without which it was difficult to implement

and complete the study. We are grateful to every one of them.

We would like to thank all the radiologists, hospitals, and diagnostic

centres which have extended their support and provided services of knee

x-rays and reports.

Prognosis is grateful to all the field investigators who have collected data

in varied climatic conditions and have played major role in successful

completion of this study.

Prognosis also acknowledges the support received from various

community representatives who facilitated the data collection and x-rays in

their respective areas.

Lastly but not the least, Prognosis is grateful to all the study participants

for willingly participating in this study and cooperating.

Aruna Deshpande

Team Leader

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Chapter 1 Executive Summary

This study was done by Prognosis Management and Research Consultants Pvt Ltd in

collaboration with IOACON Agra, to find out the Prevalence of Knee Osteoarthritis in the

Indian population and the factors associated with it.

The study was cross sectional, done across 5 sites in India, namely Pune, Agra,

Bangalore, Kolkata and Dehradun. The total sample size was 5000, split evenly across

the 5 cities. Each site was further divided into Big city, small city, town and village, to get

a proper representation of the population. Sample from each division was decided as

per population of the area. Tools consisted of a structured questionnaire. Apart from

this, x-rays AP and Lateral view of both knees were taken for each participant for

confirmation of osteo-arhritis. Diagnosis of OA was done on the basis is KL grading for

OA. KL grading 1 was considered sub threshold for OA . Grade 2 and 3 were

considered as a positive finding for OA.

The inclusion criteria were age of 40 years and above with no previous history of

fracture of lower limb or spine, SLE, rheumatoid arthritis and polyarthralgia. People

below the age of 40 years were excluded. Consent was taken from each participant

before administering the questionnaire. Only those participants who agreed for Xray and

met the inclusion criteria were included in the study.

Analysis was done using SPSS version 17. Overall prevalence of Knee Osteoarhritis

was found to be 28.7%. Site wise prevalence was found to be Agra (35.5%), Bangalore

(26.6%), Kolkata (33.7%), Dehradun (27.2%), and Pune (21.7%).The prevalence was

higher in villages (31.1%) and big cities (33.1%) as compared to town (17.1%) and small

cities (17.2%).

The associated factors were found to be female gender (prevalence 31.6%)(p value

0.007), Obesity (p value 0.04),age (p value 0.001)and sedentary work (p value 0.001)

OA prevalence was found to be significantly higher (p value 0.000) in participants who

used western toilet (42.1%) as compared to those who used Indian toilet (29.7%) or both

types (38.8%).

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Chapter 2 Introduction

Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology

characterized by loss of articular cartilage, hypertrophy of bone at the margins, sub-

chondral sclerosis and range of biochemical and morphological alterations of the

synovial membrane and joint capsule.

Pathological changes in the late stage of OA include softening, ulceration and focal are

integration of the articular cartilage; synovial inflammation also may occur. Typical

clinical symptoms are pain, particularly after prolonged activity and weight bearing;

whereas stiffness is experienced after inactivity. It is probably not a single disease but

represents the final end result of various disorders as joint failure. It is also known as

degenerative arthritis, which commonly affects the hands, feet, spine, and large weight-

bearing joints, such as the hips and knees.

Most cases of osteoarthritis have no known cause and are referred to as primary

osteoarthritis. Primary osteoarthritis is mostly related to aging. It can present as

localized, generalized or as erosive osteoarthritis. Secondary osteoarthritis is caused by

another disease or condition.

Osteoarthritis (OA) is the second most common rheumatologic problem and is most

frequent joint disease with prevalence of 22% to 39% in India.1

Osteoarthritis is more common in women than men but the prevalence increases

dramatically with age. 45% of women over the age of 65 have symptoms while

radiological evidence is found in 70% of those over 65(3). Osteoarthritis of the knee is a

major cause of mobility impairment, particularly among females. OA was estimated to be

the 10th leading cause of non-fatal burden.2

It is well recognized that osteoarthritis (OA) and osteoporosis are common

musculoskeletal disorders that frequently coexist in the same patient population.

However, what is more controversial and less well understood is the potential

relationship between these 2 processes in a given individual. For 3 decades studies

have been exploring possible relationships. Some data indicate that the 2 processes are

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not mutually exclusive and that the prevalence of osteoporosis in the OA population is

virtually identical to that seen in the “normal” population.

Self-report surveys may not accurately estimate osteoarthritis as there could be

unknown cases in the community. There are a few studies of OA that have used a

radiological classification of disease. X-ray findings do not always match symptoms but

prevalence based on radiography is probably a reasonable population estimate.

Osteoarthritis of the knee is more prevalent as per the literature available.

Therefore, for finding out the current burden of Osteoarthritis and its association with

lifestyle related factors, it was essential to undertake such a study on Prevalence of

Knee Osteoarthritis.

2.1 Known Prevalence of Osteoarthritis

Osteoarthritis indeterminately occurs in elderly age group. OA occurs commonly in

females above 45 years of age while before 45yrs it is common in males [1].In studies

done on females for identifying the relation between estrogen and prevalence of OA in

menopausal age showed contradictory results.

The prevalence of OA is available for USA and European populations as studies there

are scarce studies done in other regions. In 1990 it was 10th leading cause of non-fatal

diseases contributed 2.8% years of disability. In estimated prevalence of symptomatic

OA is 18% in females and 9.6% in men[2].In Global Burden of diseases 2000 it was 4th

leading cause of YLD leading to 3% YLD.

Sr

no

Population Year Sample

size

Diagnostic

criteria

Prevalence

Per 100,000

1 African rural

population[4]

300 Clinical

assessment

Grading based

on Kellgren &

Lawrence

M 20238

(+35)

F 30208 (+35)

2 US Citizens

non institutionalized

1971-75 6913 Radiograph

graded

M 3800(35-74)

F 7600(35-75)

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Sr

no

Population Year Sample

size

Diagnostic

criteria

Prevalence

Per 100,000

population[5]

Kellgren &

Lawrence

3 Spanish population[6]

1998-99 2998 Clinical and

ACR criteria

M 5720

F 14007(20+)

4 Framingham Heart

Study [7]

Sept 1983

Sept 1985

1805 Radiograph

graded

Kellgren &

Lawrence

7%

In studies done by Kinsala et al in 2009 it was observed that there is rapid increasing

OA in elderly population in Asian countries. As there is hastened demographic transition

in developing countries within shorter period as compared to the gradual process in

developed countries. In 2009 Haq SA studied in Asian community in as community

oriented program for control of rheumatic diseases. The COPCORD [8]study also

showed higher prevalence in urban as compared to rural prevalence of OA in

Bangladesh. In study done in Beijing urban population [9] and Wuchaun rural

population[10] it was observed that Wuchuan men had PR 1.9,95% confindence

interval,(1.3-2.9). In Chinese cohort study it shows results of two to three higher bilateral

and lateral knee prevalence as compared to Framingham Study[10]..In observational

study done in rural Tibetian region prevalence of knee pain was 25% and significantly

associated in 50yrs as compared to younger people [11].Similarly study done by Muraki S

et al, on Japaneses population symptomatic radio graphically confirmed knee OA cases

it was evidenced to have higher prevalence in two mountain regions as compared to

rural and urban population[12].

A house to house survey done by Salvi H et al in South Delhi amongst 260 peri-

menopausal women it was found to be higher in lower socioeconomic than higher

socioeconomic population[13]. In study done in Chandigarh had similar results lesser

prevalence than this study[14].

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2.2 Risk Factors of OA

Recently cohort study done by Martin et al showed that BMI is positively associated with

Knee OA in women and suggested that more activity individuals have lower risk of Knee

OA[15.In meta-analysis done by Blagojevo et al it was showed that BMI is risk factor for

OA [16]. The various modifiable risk factors are repetitive movement of joints, obesity,

infection, injuries. The occupational physical activities which including monotonous

motions and great forces such as kneeling, squatting on joints [17-24] , climbing[25], and

heavy lifting. Kellgren showed that first degree relatives of probands had twice higher

risk than others. The Genetic Osteoarthritis and progression study by Riyazi et al in

multiple sites showed evidence of familial hereditability of osteoarthritis of hand hip and

spine but not in knee[26]..

2.3 Need for prevention of OA

The irreversible nature of disease and increasing prevalence of OA in developing

countries is major concern, but since there is scarcity of studies done in India setting

which has varied socio geographical background in communities we conduct this study

for current prevalence of OA in different locations. The longeitivity of population is

increasing in India which is major concern for age related disability the difficulty in

movements, pain, stiffness of joints are common symptoms of OA. Therefore it depends

mainly on prevention of modifiable risk factors to preserve at ease movement in elderly

population.

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Chapter 3 Methodology 3.1Objectives of study

Overall Objectives

To find out the prevalence of primary knee Osteoarthritis in the Indian Population

Specific Objectives

To conduct survey at community level in selected sample geographical areas

To find out the cases with relevant symptoms of Knee Osteoarthritis and

diagnose them with the X-ray investigation

To find out factors associated with Knee Osteoarthritis

To see differences in rural/ urban population

To see differences gender-wise.

To understand the effect of lifestyle changes on OA.

To see differences among socio-economic groups.

To find out the cases with relevant symptoms and diagnose them with the

investigations

To create ground for further studies related to knee OA.

3.2 Study Design The study was a community based cross sectional study.

Sample

The cross sectional study covered all socio-economic areas. The target population was

from 4 metropolis, 4 cities near the metropolis, 4 towns and 20 villages from blocks of

these towns. i.e. 4 sample groups were covered – each sample group will comprise of

one metropolis, one city, one block headquarters (town) and 5 villages from that block.

Sample Size estimation

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The WHO TECHNICAL REPORT SERIES - 919 ‘The Burden of Musculoskeletal

Conditions at the Start of the New Millennium’ contains the BHIGWAN COPCORD Data

on prevalence of Rheumatoid Arthritis (RA) & Osteoarthritis (OA) amongst the Indian

population., was taken for reference for sample size estimation

Prevalence of osteoarthritis of the knee per 100 000 population in India as per the WHO

TECHNICAL REPORT SERIES – 919 was a Cases based on clinical ACR criteria (17).

Age Group (years)

Sex

15 to

24

25 to

34

35 to

44

45 to

59

60 to

69

70 to

79 ≥80

Males - - - 4644 15385 20 000 6250

Females - - 2247 6587 14371 19 608 14 286

Source: A. Chopra, unpublished data from Bhigwan COPCORD Study (India).

This was a community based study and this gives a total prevalence of 5.5.

Total Cases 49484

Denominator 900000

Prevalence 5.5

Thus, we consider this as “p” in the following formula for calculating sample size.

n = [t2*p(100-p)]/m2]

Where

n= required sample size

t= confidence level at 99% = value 2.58 rounded to 3

p= estimated prevalence (%) = 5.5

m= margin of error (20% of p) = 1.1

Substituting all these values we get,

Sample size n = 3866 = rounded to 3900

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Adding 20% no-response rate to this we got

Minimum sample size n = 4680

This sample was further divided into 5 sites equally (936 from each site). This was

rounded to a sample of 1000 from each site.

The further division of sample within each site was done proportionate to population i.e.

the percentage of sample was same as that of population percentage.

The initial plan for male –female distribution was to be equal; however this was not

possible as more number of Female participants were available during time of survey

Target group

This evaluation study was conducted using the household as the primary sampling unit

for the quantitative survey.

Individual respondents from households: The respondents for the study were above

40 years. One respondent from each household was selected based on the Last

Birthday Method. This method was used to ensure unbiasedness and equal age, sex

composition in the sample.

Exclusion Criteria: exclusion criteria was defined in the studies mentioned on OAI site:.

Major exclusions:

RA, inflammatory arthritis

Bilateral end-stage knee OA

Unable to walk without aids (single cane OK)

SLE

Polyarthralgia

Any other surgical or medical condition that severely limits subjects functional

ability

3.3 Research instruments: Quantitative data was collected using structured questionnaire and X-Ray Investigation.

These included:

Screening: To rule out people who belonged to exclusion criteria.

Structured questionnaire in local language and consisted of following sections –

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1. Informed Consent

2. Demographic Profile – age, sex

3. Socio-economic profile – education, occupation, income, housing conditions,

type of work and life style related information

4. Physical parameters – height, weight

5. Family History about Osteoarthritis, Osteoporosis

6. Respondents history related to Osteoarthritis, Osteoporosis – presence of

symptoms, whether diagnosed already & taking treatment, if not diagnosed,

since when symptoms present

This was followed by an X-Ray Investigation of the both the knee joints in 2 views –

Anterior-posterior view and Lateral view.

3.4 Geographical areas of study To have geographical representation from all over India Prognosis following sites were

selected:

Region (India) State Site

North / Hilly Uttarakhand Dehradun / Nainital

Central Uttar Pradesh Agra

Western Maharashtra Pune + Pimpri-Chinchwad

South Karnataka / Andhra P Bangalore / Hyderabad

East West Bengal Kolkata

From each of the 5 sites, one big city, one city, one town and 5 villages were covered.

Region

(India)

State Site Big City Small City Town Villages

North/

Hilly

Uttrakhand Dehradun Dehradun Vikas

Nagar

Sahajpur Sahaspur

Usmanpur

Rajpur

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Morallwala

Banjara

Central Uttar

Pradesh

Agra Agra Fatehpur

Sikri

Akola Angoothi

Artauni

Deoratha

Lakhanpur

Sadarban

Western Maharashtra Pune Pune Pimpri-

Chinchwad

Saswad Ambale

Rajewadi

Singapur

Waghapur

Tekawadi

South Karnataka Bangalore Bangalore Anekal Varthur Basavanpura

Channasandra

Dasarhralli

Kothanaur

Sorahunse

East West

Bengal

Kolkata Kolkata Kharda Bangaon Bairampur

Chawberia

Dharam

Pukuria

Gangrapota

Gopalnagar

X-rays Investigations:

AP and lateral views of both knees were taken. OA was graded using the Kellegren and

Lawrence scale for OA. Analysis was done based on the x-ray grading.

Ethical consideration:

Approval from ethics committee of S. N. Medical College, Agra was obtained. A written

consent was obtained from the respondents participating in the study.

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Ethics Committee Certificate

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RESULTS

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Chapter 4 Findings

4.1 Profile of sample

Table 1State-wise Distribution of Study Sample

State No Of Participantss Percentages

Pune 999 20.4

Bangalore 1005 20.5

Kolkata 993 20.2

Agra 1000 20.4

Dehradun 912 18.6

Total 4909 100.0

Figure 1 State-wise Distribution of Study Sample (%)

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The sample was equally distributed among all states. Participants’ response at Kolkata

and Dehradun was lower than other places. A total of 4909 participants were taken in

study.

Table 2 Site wise Distribution of Study Sample

Site No Of Participantss Percentages

Big city 1676 34.1

Small city 932 19.0

Town 833 17.0

Village 1468 29.9

Total 4909 100.0

Figure 2 Site wise distribution of Study Sample (%)

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The sample for sites was calculated based on actual population of the area. Accordingly,

in the overall sample consisted more people from big cities and villages, as compared to

towns and small cities.

Table 3 Site-wise distribution of Each State

State

Big City Small City Town Village Total

No % No % No % No % No

Pune 358 21.4 194 20.8 243 29.2 203 13.8 998

Bangalore 390 23.3 234 25.1 198 23.8 183 12.5 1005

Kolkata 337 20.1 174 18.7 143 17.2 339 23.1 993

Agra 304 18.1 219 23.5 143 17.2 334 22.8 1000

Dehradun 287 17.1 110 11.8 106 12.7 408 27.8 911

Total 1676 100.0 931 100.0 833 100.0 1467 100.0 4907

Figure 3 Distribution of Sample Covered

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Dehradun had a higher number of participants from rural areas (town and village) as

compared to the other states. The demarcation between city and town is very hazy in

Dehradun. Moreover, many of its city areas have attributes similar to rural parts of

Dehradun.

Table 4 Gender Distribution of total study sample

Gender No Of Participantss Percentages

Male 1763 35.9

Female 3146 64.1

Total 4909 100.0

Table 5 State-wise Gender Distribution of study sample

State

Sex Of Respondent

Total Male Female

Pune No Of Participantss 315 684 999

Percentage 31.5 68.5 100.0

Bangalore No Of Participantss 483 522 1005

Percentage 48.1 51.9 100.0

Kolkata No Of Participantss 383 610 993

Percentage 38.6 61.4 100.0

Agra No Of Participantss 285 715 1000

Percentage 28.5 71.5 100.0

Dehradun No Of Participantss 297 615 912

Percentage 32.6 67.4 100.0

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Figure 4: State Wise Gender Distribution (%)

Being a household survey, the study was dependent on the availability of participant at

home during the time of survey. As the incidence of women being at home was more

than men, the study had more female participants than male participants. The same

trend was observed in all states. Thus the study sample had approximately 36% males

and 64% females.

31.50%

48.10% 48.10% 48.10% 48.10%

68.50%

51.90% 51.90% 51.90% 51.90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pune Bangalore Kolkata Agra Dehradun

Male Female

of 185

Table 6 Distribution of Sample by Age Group

Age Group No of Participants Percentages

<50 years 2256 46.0

50 to 59 years 908 18.5

60 to 69 years 1150 23.4

>70 + years 593 12.1

Total 4909 100.0

Figure 5 Age Distribution of Sample (%)

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Table 7 Education Status of Study Sample

Education status No Of Participantss Percentages

Illiterate 2538 51.7

1st To 10th Std. 1777 36.2

11th &12th Std./ Diploma 347 7.1

Graduate & above 217 4.4

Other 30 .6

Total 4909 100.0

Figure 6 Education Status of Sample (%)

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Table 8 Occupational status of the sample

Occupation No of Participants Percent

Unemployed 343 7.0

Housewife 2071 42.2

Laborer 1017 20.7

Salaried 393 8.0

Petty Business 248 5.1

Other 837 17.1

Total 4909 100.0

Figure 7 Employment Status of Sample (%)

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Table 9 Diabetes and Hypertension status of Sample

Condition No of Participants Percent

Diabetes 526 10.7

Hypertension 1226 25.0

Figure 8: Diabetes and Hypertension of Sample (%)

Table 10 Tobacco and Alcohol consumption

Habit No of Participants Percent

Tobacco use 1809 36.9

Alcohol 378 7.7

Total 4909 100.0

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Figure 9 Tobacco and Alcohol Habits of Sample (%)

Table 11 Type of Physical Activity

Physical activity Frequency Percent

Sedentary 1521 31.0

Active 2762 56.3

Physically demanding 506 10.3

Total 4909 100.0

Figure 10 Type of Physical Activity (%)

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Table 12 Site wise distribution of Activity Type

Site Sedentary Percent Active Percent

Physically

Demanding Percent

Big city 497 32.7 1000 36.2 125 24.7

Small city 312 20.5 543 19.7 50 9.9

Town 276 18.1 436 15.8 106 20.9

Village 436 28.7 781 28.3 225 44.5

Total 1521 100.0 2760 100.0 506 100.0

Figure 11 State wise Distribution of Physical Activity Level (%)

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Table 13 Level of Physical Stress

Physical stress No of Participants Percent

Very low 932 19.0

Low 2316 47.2

High 1364 27.8

Very high 209 4.3

Total 4909 100.0

Figure 12: Level of Physical Stress of Participants (%)

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Table 14Type of Toilet used by Participants

Type of Toilet No of participants Percent

Indian 4580 93.3

Western 232 4.7

Both 74 2

Total 4886 100

Figure 13 Type of Toilet Used By Participants (%)

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Table 15 Exercise Status of Participants

Exercise No of Participants Percent

Exercise 658 13.4

No Exercise 4214 85.8

Total 4909 100.0

Figure 14 Participants Who Exercise (%)

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Work positions for ADLs

Table 16 Common Work Positions Used By Sample

Work Position No. %

Squatting 2842 57.5

Cross legged 2157 43.9

Kneeling 660 13.4

Bending 1340 27.3

Prolonged Standing 2259 46

Sitting on chair 835 17

Figure 15 Common Work Positions Used By Sample (%)

Table 17 Positions for Food Preparation

Food preparation No %

Squatting 1133 23.1

Cross legged Sitting 599 12.2

Kneeling 236 4.8

Bending 197 4

Standing 1216 24.8

Don’t prepare 2051 41.8

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Figure 16 Positions for Food Preparation (%)

Table 18 Common Positions for Sweeping

Sweeping No %

Squatting 954 19.3


Kneeling 320 6.5

Bending 197 4

Standing 526 10.7

Don’t sweep 2051 41.8

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Figure 17 Common Positions for Sweeping(%)

Table 19 Common Position for Mopping

Mopping Position No %

Squatting 1249 25.4

Kneeling 375 7.6

Bending 733 14.9

Standing 367 7.5


Figure 18: Common Position for Mopping (%)

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Table 20 Positions Used for Religious Activities

Religious Activities No %

Squatting 1177 24


Kneeling 450 9.2

Bending 597 12.2

Standing 1983 40.4

Don’t perform 793 16.2

Figure 19 Positions Used for Religious Activities (%)

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4.3 Symptomatic Prevalence

Table 21 State Wise Distribution Of Participants With Pain In Knees In Last 5

Years And In Last 3 Months

Figure 20 Pain Symptoms of Participants

Symptom

Pune

Bangalore

Kolkata

Agra

Dehradun

Total

No % No % No % No % No % No %

Pain in last 5

years 385 38.5 635 63.2 787 79.3 939 93 821 90 3567 72.7

Pain in last 3

months 210 21 35 3.5 649 65.4 825 82.5 684 75 2403 49

of 185

Table 22 Swelling in Knee

Swelling in Knee Number Percent

Never 3390 69.1

Rarely 419 8.5

Sometimes 697 14.2

Most times 275 5.6

Always 128 2.6

Total 4909 100.0

Figure 21: Swelling in Knee (%)

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Table 23 Grinding Sensation in Knee

Grinding in knee Number Percent

Never 3287 66.9

Rarely 472 9.6

Sometimes 726 14.8

Most times 337 6.9

Always 83 1.7

Total 4909 100.0

Figure 22: Grinding Sensation in Knees (%)

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Table 24 Clicking Noise in Knees

Clicking in Knee Frequency Percent

Never 3144 74.0

Rarely 420 8.6

Sometimes 839 17.1

Most times 372 7.6

Always 130 2.6

Total 4909 100.0

Figure 23 Clicking Noise in Knees (%)

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Table 25 Catch in Knees

Figure 24 Clicking Noise in Knees

Catch in knee Number Percent

Never 3138 63.9

Rarely 452 9.2

Sometimes 740 15.1

Most times 283 5.8

Always 293 6.0

Total 4909 100.0

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Table 26 Frequency of Knee Pain

Frequency of knee pain Number Percent

Never 2557 52.0

Once a month 237 4.8

Once a week 467 9.5

Daily 823 16.8

Always 821 16.7

Total 4909 100.0

Figure 25 Frequency of Knee Pain

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Table 27 Symptom of Knee Stiffness

Stiffness in Knee Number Percent

Stiffness 1427 29.1

No Stiffness 3482 71.0

Total 4909 100.0

Figure 26: Stiffness in Knee (%)

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Visual Analogue Scale rating of Symptoms

Table 28 Pain Level of Participants When Standing From Sitting Position

Pain level Frequency Percent

No pain 195 8.4

Mild 921 39.9

Moderate 999 43.3

Severe 194 8.4

Figure 27: Pain Level of Participants When Standing From Sitting Position (%)

Table 29 Pain Level While Going Up Stairs


No pain 183 8.2

Mild 634 28.6

Moderate 1065 48.0

Severe 338 15.2

Total 2220 100.0

of 185

Figure 28 Pain Level While Going Up Stairs (%)

Table 30 Pain Level While Going Downstairs


No pain 224 10.0

Mild 764 34.1

Moderate 962 42.9

Severe 291 13.0

Total 2241 100.0

Figure 29 Pain Level While Going Downstairs (%)

Table 31 Pain Level While Straightening Knee

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No pain 472 20.2

Mild 1063 45.4

Moderate 711 30.4

Severe 93 4.0

Total 2339 100.0

Figure 30 Pain Level While Straightening Knee (%)

Table 32 Pain Level While Bending Knee


No pain 379 16.3

Mild 1055 45.4

Moderate 768 33.1

Severe 121 5.2

Total 2323 100.0

of 185

Figure 31 Pain Level While Bending Knee (%)

Table 33 Pain Level While Getting Into Bus

Pain Level Frequency Percent

No pain 495 21.7

Mild 911 40.0

Moderate 709 31.1

Severe 164 7.2

Total 2279 100.0

of 185

Figure 32 Pain Level While Getting Into Bus (%)

Table 34 Pain While Getting into Car/Auto rickshaw


No pain 686 29.8

Mild 917 39.8

Moderate 557 24.2

Severe 143 6.2

Total 2303 100.0

of 185

Figure 33 Pain While Getting Into Car/Auto rickshaw (%)

Table 35 Pain While Putting On Socks/Undergarments


No pain 919 39.2

Mild 883 37.6

Moderate 489 20.8

Severe 55 2.3

Total 2346 100.0

of 185

Figure 34: Pain While Putting On Socks/Undergarments (%)

Table 36 Pain While Getting On/Off Toilet


No pain 315 14.8

Mild 666 31.4

Moderate 828 39.0

Severe 314 14.8

Total 2123 100.0

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Figure 35: Pain While Getting On/Off Toilet (%)

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4.4 PREVALENCE of OA by RADIOLOGICAL DIAGNOSIS Knee x-ray of each participant was taken and AP and lateral views of both knees were

recorded. OA was graded using the Kellegren and Lawrence scale for OA.

Following reporting format used was shared with all participating diagnostic centres:

Kellegren And Lawrence grade

KL description

0

No osteophytes, normal joint space

1

Doubtful narrowing, possible osteophytes

2

Minimal but definite osteophytes, joint space

3 Definite and moderate osteophytes joint space narrow, some sub-chondral sclerosis

If either of the knees X-ray grade is 2 or 3 the participant is diagnosed as decisive OA.

Table 37: OA Status of Indian Population

OA Status No Of Participants Percentage

No OA 3497 71.3

OA 1412 28.7

Total 4909 100.0

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Figure 36: OA prevalence (%)

Radiological grading of 1 on either of the knee is considered to be doubtful. Such participants

are labelled as sub-threshold participants.

If they are made aware of their problems and of proper care to be taken with exercise then

these participants can successfully turn back to or stay as NON-OA in future.

Percentage of such participants (Grade 1) is 24.6 which is as equal as the percentage of OA.

This has to noted and steps to work on such participants to be taken seriously.

Table 38State-wise Prevalence of OA

OA

Status

Pune Bangalore Kolkata Agra Dehradun

No. % No. % No. % No. % No. %

No OA 782 78.3 738 73.4 668 67.3 645 64.5 664 72.8

OA 217 21.7 267 26.6 325 32.7 355 35.5 248 27.2

Total 999 1005 993 1000 912

of 185

Figure 37 State wise Prevalence of OA (%)

Figure 38 Site wise Distribution of OA for Sample (%)

of 185

Table 39 Site-wise Distribution of Prevalence of OA for each state

OA Status No /Prevalence Big City Small City Town Village

OA Status of Pune Numbers 73 40 57 47

Prevalence (%) 20.4 20.5 23.5 23.2

OA Status of

Bangalore

Numbers 90 88 60 29

Prevalence (%) 23.1 37.6 30.3 15.8

OA Status of Kolkata Numbers 107 50 54 114

Prevalence (%) 31.8 28.7 37.8 33.6

OA Status of Agra Numbers 115 63 69 108

Prevalence (%) 37.8 28.8 48.3 32.3

OA Status of

Dehradun

Numbers 84 32 18 114

Prevalence (%) 29.3 29.1 17 27.9

Total Number 464 249 251 436

Prevalence (%) 33.1 17.8 17.9 31.1

Figure 39 Site wise Prevalence of OA in Each State

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4.4 ASSOCIATED FACTORS

As described in earlier section, studies have shown some association of OA with Age, Sex, BMI

and life style related factors. An attempt is made to confirm these associations in a large sample

so that the information can be used in awareness generation programmes ahead.

Table 40 Gender and OA

OA status

Male Female

No % No %

No OA 1281 72.7 2216 70.4

OA 482 27.3 930 29.6

Total 1644 100 2964 100

Figure 40 Gender Difference in OA Prevalence

The association of gender and OA of this study are in congruence with available literature on

Knee Osteo-arthritis. OA of the knees was found to be more prevalent in females (29.6%) than

in males (27.3%). But this difference is statistically not significant (p value = 0.09) in this sample.

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BMI and OA

Table 41 BMI and OA

OA status

Underweight

Normal

Obese

P value

No. % No. % No. %

OA 117 28 616 28.7 618 33 0.007

No OA 301 72 1530 71.3 1257 67

Figure 41 Prevalence of OA According to BMI

The study found that prevalence of OA knees increased with increase in BMI. Knee OA

prevalence was significantly high in obese participants(33%) as compared to

underweight people (28%) and normal weight (28.7%).

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Age and OA

Table 42 Prevalence of OA Knees with Age

OA status

<50 years

50-59 years

60-69 years

70+ years

P value

No. % No. % No. % No. %

OA 405 19.2 261 30.7 430 39.7 304 54.1 0.001

No OA 1708 80.8 589 69.3 653 60.3 258 45.9

Figure 42: Association of Age and Knee OA

Our study findings are in line with the proven fact that the prevalence of OA increase

with the increase in Age. The prevalence was highest in among the age group of 60 and

above, and lowest in people in the age group of 40-50 years.

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Table 43 Activity Level and OA

OA

status

Sedentary

Active

Demanding

p value

No. % No. % No. %

OA 548 36.8 696 26.6 134 30.4 0.001

No OA 947 63.2 1919 73.4 307 69.6

Figure 43 Physical activity level and OA prevalence (%)

Prevalence was highest in participants who have a sedentary lifestyle followed by

participants with a physically demanding lifestyle and active lifestyle. This difference was

statistically significant (p value 0.001) showing that OA prevalence was lowest in

participants who had a fairly active physical activity level.

Since the study recorded the current level of physical activity, it may be possible that

geriatric participants were included in the sedentary group. In those cases, the

possibility of having OA may be more due to age rather than lifestyle. Moreover, people

with severe OA may have changed their lifestyle.

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Toilet type and OA

Table 44 Toilet type and OA

OA status

Indian

Western

Both

P value

No. % No. % No. %

OA 1280 29.7 88 42.1 26 38.8 0.001

No OA 3034 70.3 121 57.9 41 61.2

Figure 44 Toilet Type Used and OA (%)

OA prevalence was found to be significantly more (p value 0.001) in participants who

used western toilet (42.1%) as compared to those who used Indian toilet(29.7%) or both

types (38.8%).

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Table 45 Exercise and OA Prevalence

OA status

Regular Exercise

No Exercise

P value

No. % No. %

OA 224 36 1175 83.9 0.02

No OA 416 65 2790 87

Figure 45 : Exercise Level and OA

Prevalence was higher in participants who do not exercise (82.9%) compared to

participants who exercise (36). Although the questionnaire gathered information on type

of exercises done, there was no significant difference in prevalence of OA among

different exercise groups.

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4.5 Presence of Symptoms and OA

Table 46 Pain and Stiffness in People with OA

Pain & Stiffness

OA P value

Number %

Pain in last 5 years 1103 78.8 0.001

Pain in last 3 months 811 57.9 0.001

Stiffness in Knee 486 35.8 0.001

Figure 46: OA Prevalence In Participants With Pain And Stiffness Symptoms

78.8% participants who had OA according to x-ray diagnosis had pain sometime in the

past 5 years. 57.9% of participants with OA had pain sometime in the last 3 months and

35.8% of participants with OA had experienced knee stiffness at least once in the last 3

months.

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Other Knee Symptoms and OA

Table 47 Frequency of Symptoms In People With OA

Symptom Never (%)

Rarely

(%)

Sometimes

(%)

Most times

(%)

Always

(%)

p

value

Grinding 33.5 32.4 35.5 43.1 40 0.001

Clicking 33.3 31.7 35 40.7 46 0.001

Catching 31.4 32.8 39.6 39.6 33.8 0.001

Figure 47: Frequency Of Symptoms In Participants With OA (%)

The symptoms of Grinding sensation, clicking noise and catch feeling in the knee

occurred always in approximately 40% of the participants who had OA.

Table 48 Prevalence of OA As Compared To Pain While Getting Up From Sitting Position

OA Status

Mild Moderate Severe P value

No. % No. % No. %

0.570 (Not Significant)

No OA 630 68.4 701 70.2 140 72.2 OA 291 31.6 298 29.8 54 27.8

Total 921 100 999 100 194 100

of 185

Table 49 Prevalence of OA As Compared To Pain While Climbing Stairs

OA Status


No. % No. % No. %


No OA 444 70.0 756 71.0 222 65.7

OA 190 30.0 309 29.0 116 34.3

Total 634 100 1065 100 338 100

Table 50 Prevalence Of OA As Compared To Pain While Going Down Stairs

OA Status


No. % No. % No. %


No OA 540 70.7 670 69.6 198 68.0

OA 224 29.3 292 30.4 93 32.0

Total 764 100.0 962 100.0 291 100.0

Table 51 Prevalence of OA As Compared To Pain While Straightening Knee

OA Status


No. % No. % No. %


No OA 730 68.7 497 69.9 66 71.0

OA 333 31.3 214 30.1 27 29.0

Total 1063 100.0 711 100.0 93 100.0

52 Table Prevalence Of OA As Compared To Pain While Bending Knee

Table 53 Prevalence Of OA As Compared To Pain While Getting Into Bus

OA Status


No. % No. % No. %


No OA 732 69.4 524 68.2 91 75.2

OA 323 30.6 244 31.8 30 24.8

Total 1055 100.0 768 100.0 121 100.0

OA Status


No. % No. % No. %


No OA 641 70.4 502 70.8 110 67.1 OA 270 29.6 207 29.2 54 32.9

Total 911 100.0 709 100.0 164 100.0

of 185

Table 54 Prevalence Of OA As Compared To Pain While Getting Into Car

Table 55 Prevalence of OA As Compared To Pain While Putting On Socks

Table 56 Prevalence of OA As Compared To Pain While Getting On /Off Toilet

OA Status


No. % No. % No. %


No OA 632 68.9 388 69.7 101 70.6 OA 285 31.1 169 30.3 42 29.4

Total 917 100.0 557 100.0 143 100.0

OA Status


No. % No. % No. %


No OA 628 71.1 327 66.9 39 70.9

OA 255 28.9 162 33.1 16 29.1

Total 883 100.0 489 100.0 55 100.0

OA Status


No. % No. % No. %


No OA 464 69.7 594 71.7 224 71.3

OA 202 30.3 234 28.3 90 28.7

Total 666 100.0 828 100.0 314 100.0

of 185

State Wise Findings

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Chapter 5 Uttar Pradesh Analysis (Site – Agra)

General Profile of Agra Population

The sample for Agra was 1000. The areas covered were as follows

Site Name of Area

Big city Agra city

Small city Fatehpur Sikri

Town Akola

Villages Angoothi, Artauni, Deoratha, Lakhanpur and

Sadarban

Table 57 Gender Distribution in Agra

Gender No of Participants Percent

Male 285 28.5

Female 715 71.5

Total 1000 100.0

Figure 48: Gender distribution In Agra (%)

of 185

Table 58 Site wise Distribution of Participants In Agra

Site No of Participants Percent

Big city 304 30.4

Small city 219 21.9

Town 143 14.3

Village 334 33.4

Total 1000 100.0

Figure 49 Site wise Distribution of Participants In Agra (%)

of 185

Table 59 Age Distribution of Participants In Agra

Age Group No of Participants Percent

<50 491 49.1

50 to 59 170 17.0

60 to 69 216 21.6

>70 + 123 12.3

Total 1000 100.0

Figure 50 Age Distribution of Participants in Agra (%)

of 185

Table 60 Occupation distribution of Participants in Agra


Unemployed 29 2.9

Housewife 558 55.8

Daily wage worker 156 15.6

Salaried employee 57 5.7


Other 156 15.6

Total 1000 100.0

Figure 51 Occupation Distribution of Participants in Agra (%)

of 185

Table 61 Educational Status of Participants in Agra

Education Category No of participants Percent

Illiterate 621 62.1

1st To 10th Std. 289 28.9



Other 1 .1

Total 1000 100.0

Table 62 Diabetes Prevalence in Agra Sample

Diabetes No of participants Percent

Present 61 6.1

Absent 939 93.9

Total 1000 100.0

Table 63 Hypertension in Agra Sample

Hypertension No of participants Percent

Present 299 29.9

Absent 701 70.1

Total 1000 100.0

Table 64 Coronary Artery Disease in Agra Sample

CAD No Of Participantss Percent

Present 23 2.3

Absent 977 97.7

Total 1000 100.0

of 185

Table 65 Tobacco and Alcohol Habits in Agra Sample

Lifestyle No of participating Percent

Tobacco Users 497 49.7

Alcohol Consumption 56 5.6

Table 66 Tobacco Use Pattern in Agra Sample

Tobacco use pattern No of Participants Percent

Smoking 183 18.3

Chewing 266 26.6

Applying Mishri 156 15.6

Total 497 49.7

Table 67 Level of Physical activity in Agra Sample

Type of Physical Activity No of participants Percent

Sedentary 423 42.3

Active 538 53.8


Total 1000 100.0

of 185

Figure 52: Physical Activity Level in Agra Sample (%)

Table 68 Level of Physical Stress in Agra Sample

Physical stress level No Of participants Percent

None 168 16.8

Very low 221 22.1

Low 369 36.9

High 193 19.3

Very high 42 4.2

Total 1000 100.0

Table 69 Common Work Positions Used In Agra

Work Position No. %

Squatting 791 79.1


Kneeling 44 4.4

Bending 168 16.8

Prolonged Standing 517 51.7

Sitting on chair 174 17.4

of 185

Figure 53 Common Work Positions Used In Agra (%)

Table 70 Positions Used For Food Preparation in Agra

Food Preparation No %

Squatting 347 34.7


Kneeling 10 1

Bending 6 0.6

Standing 106 10.6


of 185

Figure 54 Positions Used For Food Preparation in Agra (%)

Table 71 Positions Used For Sweeping in Agra

Sweeping No %

Squatting 243 24.3

Kneeling 16 1.6

Bending 274 27.4

Standing 65 6.5


of 185

Figure 55 Positions Used For Sweeping In Agra (%)

Table 72 Positions Used For Mopping In Agra

Mopping No %

Squatting 267 26.7

Kneeling 14 1.4

Bending 81 8.1

Standing 15 1.5

Don’t mop 653 65.3

of 185

Figure 56 Positions Used For Mopping In Agra (%)

Table 73 Positions Used For Religious Activities in Agra


Squatting 281 28.1


Kneeling 74 7.4

Bending 22 2.2

Standing 493 49.3


of 185

Figure 57 Positions Used For Religious Activities in Agra (%)

Table 74Type of Toilet Used In Agra

Type of Toilet Use No of participants Percent

Indian 967 96.7

Western 24 2.4

Both 9 .9

Total 1000 100.0

Table 75 Exercise Status of Agra Sample

Exercise status No of participants Percent

Exercise 117 11.7


Total 1000 100.0

of 185

5.2 PREVALENCE OF SYMPTOMS

Table 76 Participants Who Had Pain In Knee In The Past 5 Years In Agra

Knee pain status in last 5 years No of Participants Percent

Yes 939 93.9

No 61 6.1

Total 1000 100.0

Table 77 Participants Who Had Pain In Knees In The Past 3 Months In Agra

Knee pain status in last 3 months No of Participants Percent

Yes 825 82.5

No 175 17.5

Total 1000 100.0

Figure 58 Pain in Last 5 Years and Pain in last 3 Months (%)

of 185

Table 78 Participants Who Had Swelling in The Knee In Agra

Swelling over Knee No of Participants Percent

Never 460 46.0

Rarely 115 11.5

Sometimes 296 29.6

Most of the times 90 9.0

Always 39 3.9

Total 1000 100.0

Table 79 Participants Who Had Grinding Sensation in The Knee In Agra

Grinding pain in knee No Of Participants Percent

Never 377 37.7

Rarely 119 11.9

Sometimes 307 30.7


Always 40 4.0

Total 1000 100.0

Table 80 Participants Who Had Clicking Noise In Knee In Agra

Hear Clicking or Noise In Knee No of participants Percent

Never 401 40.1

Rarely 101 10.1

Sometimes 315 31.5


Always 58 5.8

Total 1000 100.0

of 185

Table 81 Participants Who Had Knee Catch In Agra

Knee catch or Hang up in knee No of participants Percent

Never 289 28.9

Rarely 81 8.1

Sometimes 265 26.5


Always 220 22.0

Total 1000 100.0

Table 82 Participants Who Experienced Knee Stiffness In Agra

Experience of stiffness No of participants Percent

Yes 486 48.6

No 514 51.4

Total 1000 100.0

of 185

5.3 Prevalence of Knee OA by Radiological Diagnosis

Table 83 Prevalence Of OA Knees In Agra

OA Status No of participants Percent

No OA 645 64.5

OA 355 35.5

Total 1000 100.0

Figure 59: Prevalence in Agra (%)

Table 84 Gender Wise Prevalence Of Knee OA In Agra

OA Status Sex of the Respondent

Total Male Female

Numbers 85 269 355

Prevalence of OA (%) 24.0 76.0 100.0

of 185

Table 85 Site Wise Prevalence Of OA In Agra

OA Big city Small city Town Village Total

Numbers 114 66 69 105 355

Prevalence of OA 32.2 18.6 19.5 29.7 100.0

Figure 60: Site Wise Prevalence in Agra

Table 86 OA by Knee Involvement in Agra

Knee Involvement OA Status

Numbers Percentage (%)

Right Knee OA 284 28.4

Left Knee OA 287 28.7

Both Knees OA 218 21.8

of 185

5.4 Associated Factors for OA

Table 87 Gender and OA in Agra

OA status

Male

Female

P value

No. % No. %

OA 85 8.5 269 26.9 0.012

No OA 200 20 446 45

Figure 61: Association of OA and Gender in Agra (%)

Table 88 OA and Age in Agra

OA

status

<50 years

50-59 years

60-69 years

70+ years

P value

No. % No. % No. % No. %

OA 125 25.5 61 35.9 94 43.5 74 60.2 0.001

No OA 366 74.5 109 64.1 122 56.5 49 7.6

of 185

Figure 62: Association of Age and OA in Agra (%)

Table 89 BMI and OA in Agra

OA Status

Underweight

Normal

Obese

P value

No. % No. % No. %

OA 31 28.7 146 30.7 177 42.7 0.001

No OA 77 71.3 329 69.3 238 57.3

Figure 63: Association on BMI and OA (%)

of 185

Table 90 OA and Occupation Status in Agra

OA Status Unemployed

(%)

Housewife

(%)

Laborer

(%)

Salaried

(%)

Business

(%)

Other

(%)

P value

OA 44.8 36.7 25 36.8 36.4 38.5 0.86

(not

sig)

No OA 55.2 63.3 75 63.2 63.6 61.5

Table 91 OA and level of Physical Activity in Agra

OA status

Sedentary Active Demanding P value

No. % No. % No. %

OA 179 42.3 157 29.2 17 48.6 0.001

No OA 244 57.7 381 70.8 18 51.4

Table 92 Type of Toilet and OA in Agra

OA Status

Indian Western Both P Value

No. % No. % No. %

OA 333 94.1 14 58.3 7 77.8 0.002

No OA 634 98.1 10 41.7 2 22.2

of 185

Figure 64: Type of Toilet and OA In Agra

Table 93 Lifestyle factors and OA in Agra

Characteristic No. % P value

Exercise 47 40.2 0.3 (not significant)

Tobacco use 157 31.6 0.01

Alcohol 17 30.4 0.51 (not significant)

of 185

Chapter 6 Maharashtra State Analysis (Site: Pune) Table 94 Distribution Of Sample Size By Gender In Pune Sample

Gender No Of participants Percent

Male 315 31.5

Female 684 68.5

Total 999 100.0

Figure 65 Gender Distribution in Pune Sample (%)

of 185

Table 95 Site-Wise Distribution of Sample Of Pune

Type of site No of participants Percent

Big city 358 35.8

Small city 195 19.5

Town 243 24.3

Village 203 20.3

Total 999 100.0

Figure 66 Site Wise Distribution of Sample in Pune

of 185

Table 96 Distribution of Sample By Age Group In Pune Sample

Age Group No of

participants Percent

<50 377 37.7

50 to 59 193 19.3

60 to 69 296 29.6

>70 + 133 13.3

Total 999 100.0

Figure 67 Age-wise Sample Distribution In Pune

of 185

Table 97 Occupation Status of Population of Pune

Occupation Type No of participants Percent

Unemployed 56 5.6

Housewife 405 40.5




Other 272 27.2

Total 999 100.0

Figure 68 Occupation Wise Distribution of Sample In Pune

of 185

Table 98 Educational Status of Pune Sample

Education status No of participants Percent

Illiterate 394 39.4

1st To 10th Std. 475 47.5



Other 7 .7

Total 999 100.0

Table 99 People with Diabetes in Pune Sample

Diabetic status No of participants Percent

Yes 130 13.1

No 869 86.9

Total 999 100.0

Table 100 People with Hypertension in Pune Sample

HTN Status No of participants Percent

Yes 183 18.3

No 816 81.7

Total 999 100.0

of 185

Table 101 People with CAD In Pune Sample

CAD Status No of participants Percent

Yes 30 3.0

No 969 97.0

Total 999 100.0

Table 102 Tobacco Users In Pune Sample

Tobacco Use No of participants Percent

Yes 501 50.2

No Tobacco use 498 49.8

Total 999 100.0

Table 103 Pattern Of Tobacco Users In Pune Sample

Form of Tobacco No of participants Percent

Smoking 59 5.9

Chewing 257 25.7

Applied Mishri 246 24.6

of 185

Table 104 Alcohol Consumption Status Of Population In Pune Sample

Alcohol Status No of Participants Percent

No Alcohol consumption 916 91.7

Alcohol consumption 83 8.3

Total 999 100.0

Table 105 Type of Physical Activity In Pune Sample

Type of physical activity No of participants Percent

Sedentary 298 29.8

Active 563 56.4


Total 999 100.0

Figure 69 Distribution Of Physical Activity Level In Pune (%)

of 185

Table 106 Physical stress Level In Pune Sample

Physical Stress No of Participants Percent

None 118 11.8

Very low 120 12.0

Low 361 36.1

High 369 36.9

Very high 32 3.2

Total 999 100.0

Table 107 Commonly Used Work Positions In Pune

Work Position No. %

Squatting 537 53.8


Kneeling 47 4.7

Bending 354 35.4



Figure 70 Commonly Used Work Positions In Pune (%)

of 185

Table 108 Positions Used For Food Preparation In Pune


Squatting 193 19.3


Kneeling 8 0.8

Bending 5 0.5

Standing 245 24.5


Figure 71 Positions Used For Food Preparation In Pune (%)

Table 109 Positions Used For Sweeping In Pune

Sweeping No %

Squatting 106 10.6

Kneeling 11 1.1

Bending 429 42.9

Standing 117 11.7

Don’t sweep 430 43

of 185

Figure 72 Positions Used For Sweeping In Pune (%)

Table 110 Positions Used For Mopping In Pune

Mopping No %

Squatting 245 24.5

Kneeling 44 4.4

Bending 165 16.5

Standing 80 8

Don’t mop 459 45.9

of 185

Figure 73 Positions Used For Mopping In Pune (%)

Table 111 Positions Used For Religious Activities In Pune

Religious activities No %

Squatting 132 13.2


Kneeling 62 6.2

Bending 16 1.6

Standing 244 24.4


of 185

Figure 74 Positions Used For Religious Activities In Pune (%)

Table 112 Type of Toilet Use

Type of Toilet No of participants Percent

Indian 939 94.0

Western 39 3.9

Both 21 2.1

Total 999 100.0

Table 113 Exercise Status of Pune Sample

Exercise Status No of participants Percent

Exercise 152 15.2


Total 999 100.0

of 185

6.1 Prevalence by Symptoms

Table 114 Pain In Knees Anytime In The Last 5 Years

Pain in knee in last 5 years No of participants Percent

Yes 385 38.5

No 613 61.5

Total 999 100.0

Table 115 Pain In Knees Anytime In The Last 3 Months

Pain in knee in last 3 months No of participants Percent

Yes 210 21.1

No 789 78.9

Total 999 100.0

Figure 75 Pain in the last 5 years and Pain in last 3 months in Pune sample

of 185

Table 116 Swelling of Knee joint

Swelling over Knee No of participants Percent

Never 886 88.6

Rarely 46 4.6

Sometimes 40 4.0


Always 12 1.2

Total 999 100.0

Table 117 Grinding Pain of Knee joint

Grinding Pain No of participants Percent

Never 934 93.4

Rarely 30 3.0

Sometimes 19 1.9


Always 4 .4

Total 999 100.0

Table 118 Clicking Pain of Knee joint

Hear Clicking pain in Knee No of participants Percent

Never 889 88.9

Rarely 41 4.1

Sometimes 32 3.2


always 22 2.2

Total 999 100.0

Table 119 Knee catch while moving

Knee Catch or Hang Up pain No of participants Percent

Never 867 86.7

Rarely 49 4.9

Sometimes 46 4.6


Always 24 2.4

Total 999 100.0

of 185

Table 120 Stiffness in Knee Joint

Stiffness In Knee Joint No of Participants Percent

Stiffness Yes 117 11.7

No 882 9.1

Total 999 100.0

6.2 Prevalence of OA by Radiological Diagnosis

Table 121 Prevalence of OA in Pune

OA Status Frequency Percent

No OA 782 78.3

OA 217 21.7

Total 999 100.0

Figure 76: OA prevalence in Pune

of 185

Table 122 Prevalence of OA by Gender

OA Sex of the respondent

Male Female Total

Count 75 140 215

Prevalence (%) 34.9 65.1 100.0

Table 123 Site-wise Prevalence of OA

OA

Site

Big city Small city Town Village

Count 73 40 57 47

Prevalence (%) 20.4 20.5 23.5 23.2

Figure 77 Site wise distribution of Prevalence in Pune Sample

Table 124 Prevalence of OA by Knee Involvement

Knee Involvement OA Status

No of participants Percent

Right Knee 200 20.0

Left Knee 193 19.3

Both Knee 176 17.6

of 185

6.3 Associated Factors

Table 125 Association of Gender and OA

OA Status

Male Female

P Value

No % No. %

N.S

No OA 193 30.3 443 69.7

OA 75 34.9 140 65.1

Table 126 Association of Age and OA

OA

Status

<50 50 to 59 60 to 69 >70 + P value

No (%) No. (%) No (%) No. (%)

0.000

No OA 285 44.8 124 19.5 178 28 49 7.7

OA 22 10.2 38 17.7 83 38.6 72 33.5

Figure 78: Association of Age and OA in Pune

of 185

Table 127 Association of OA and BMI

OA Status

Underweight Normal BMI Overweight

Total No (%) No (%) No (%)

No OA 34 5.5 264 42.6 321 51.9 0.07 (M.S) OA 4 1.9 99 47.4 106 50.7

Figure 79: Association of OA and BMI in Pune (%)

Table 128 Association of OA and Occupation in Pune

OA status

Unemployed Housewife Laborer Salaried Business Other P value

No OA 23 (3.6) 268(42.1) 110(17.3) 40(6.3) 43 (6.8) 152 (23.9) 0.000

OA 22(10.2) 91(42.3) 17(7.9) 7(3.3) 7(3.3) 71(33.0)

of 185

Figure 80: Association on OA and Occupation and OA in Pune

Table 129 Association of OA and Physical activity level in Pune

OA Status

Sedentary Active Physically demanding

P value

No OA Numbers 155 380 87 0.000

Prevalence% 24.4 59.7 13.7

OA Numbers 85 103 20

Prevalence % 39.5 47.9 9.3

Table 130 Association of OA and toilet type in Pune

OA Status Indian Western Both P value

No OA Numbers 603 21 12 N.S

Prevalence (%) 94.8 3.3 1.9

OA Numbers 201 9 5

Prevalence (%) 93.5 4.2 2.3

of 185

Table 131 Association of OA and Exercise in Pune

OA status Exercise No exercise Total

No OA Numbers 91 539 N.S

Prevalence (%) 14.3 84.7

OA Numbers 35 177


Table 132 Association of OA and Tobacco Use in Pune

OA status Tobacco Use No Tobacco Total



OA Numbers 118 97


Table 133 Association of OA and smoking in Pune

OA status No Smoking Smoking P value



OA Numbers 205 10


of 185

Table 134 Association of OA and Alcohol in Pune

OA status Alcohol

Consumption No Alcohol Total



OA Numbers 23 192


of 185

Chapter 7 West Bengal State Findings

Site: Kolkata)

Table 135 Gender Distribution of population Of Kolkata

Gender No of participants Percent

Male 383 38.6

Female 610 61.4

Total 993 100.0

Figure 81: Gender distribution in Kolkata sample

of 185

Table 136 Site-wise Distribution of Population

Site No of participants Percent

Big city 337 33.9

Small city 174 17.5

Town 143 14.4

Village 339 34.1

Total 993 100.0

Figure 82 Site wise distribution of Kolkata sample (%)

of 185

Table 137 Distribution of population by Age group

Age Group No of participants Percent

<50 years 545 54.9

50 to 59 years 206 20.7

60 to 69 years 167 16.7

>70 + years 75 7.6

Total 993 100.0

Figure 83 Age distribution of Kolkata sample (%)

of 185

Table 138 Occupational status of population

Occupation No of participants Percent

Unemployed 105 10.6

Housewife 352 35.4

Laborer 145 14.6

Salaried 135 13.6

Business 81 8.2

Other 175 17.6

Total 993 100.0

Figure 84 Occupation distribution of sample in Kolkata

of 185

Table 139 Educational status of population

Educational status No of participants Percent

Illiterate 420 42.3

1st To 10th Std. 391 39.4



Other 16 1.6

Total 993 100.0

Table 140 Diabetic status of sample in Kolkata

Diabetes Status No of participants Percent

Present 104 10.5

Absent 889 89.5

Total 993 100.0

of 185

Table 141 Hypertension Status of sample in Kolkata


Hypertension 219 22.1

No Hypertension 774 77.9

Total 993 100.0

Table 142 CAD Status of sample in Kolkata

CAD Status No of participants Percent

CAD disease 114 11.5

No CAD disease 879 88.5

Total 993 100.0

Table 143 Tobacco Use of sample in Kolkata

Tobacco users No of participants Percent

Tobacco 287 28.9

No Tobacco 706 71.9

Total 993 100.0

of 185

Table 144 Tobacco use pattern in Kolkata sample

Tobacco use pattern No of participants Percent

Smoking 178 17.9

Chewing 111 11.2

Applied Mishri 94 9.5

Table 145 Alcohol consumption of Kolkata sample

Alcohol Consumption No of participants Percent

No Alcohol 946 95.2


Total 993 100.0

Table 146 Type of activity of Kolkata sample

Type of activity No of participants Percent

Sedentary 315 31.7

Active 327 32.9


Total 993 100.0

of 185

Figure 85 Physical activity level of Kolkata sample

Table 147 Physical stress level of Kolkata sample

Physical stress level No of participants Percent

None 158 15.9

Very low 157 15.8

Low 272 27.4

High 310 31.2

Very high 96 9.7

Total 993 100.0

of 185

Table 148 Commonly Used Work Positions In Kolkata

Work Position No. %

Squatting 660 66.5


Kneeling 403 40.6

Bending 373 37.6



Figure 86 Commonly Used Work Positions In Kolkata (%)

Table 149 Positions Used For Food Preparation In Kolkata


Squatting 317 31.9


Kneeling 144 14.5

Bending 92 9.3

Standing 236 23.6


of 185

Figure 87 Positions Used For Food Preparation In Kolkata (%)

Table 150 Positions Used For Sweeping In Kolkata

Sweeping No %

Squatting 204 20.5

Kneeling 292 29.4

Bending 168 16.9

Standing 140 14


of 185

Figure 88 Positions Used For Sweeping In Kolkata (%)

Table 151 Positions Used For Mopping In Kolkata

Mopping No %

Squatting 277 27.9

Kneeling 208 20.9

Bending 181 18.2

Standing 65 6.5

Don’t mop 412 41.5

of 185

Figure 89 Positions Used For Mopping In Kolkata (%)

Table 152 Positions Used For Religious Activities In Kolkata

Religious activity No %

Squatting 318 32.1


Kneeling 176 17.7

Bending 100 10.1

Standing 271 27.3


of 185

Figure 90 Positions Used For Religious Activities In Kolkata (%)

Table 153 Type of Toilet Used in Kolkata

Type of toilet No of participants Percent

Indian 874 88.0

Western 107 10.8

Both 12 1.2

Total 993 100.0

of 185

Table 154 Exercise status of Kolkata sample


Exercise 189 19.0

No exercise 804 81.0

Total 993 100.0

6.1 Prevalence by Symptoms

Table 155 Knee pain status in last 5 years of Kolkata sample

Knee pain status in

last 5 years No of participants Percent

Knee pain 787 79.3

No pain 206 20.7

Total 993 100.0

Table 156 Knee pain status in last 3 months of Kolkata sample

Knee pain status in last 3 months No of participants Percent

Knee Pain 649 65.4

No pain 344 34.6

Total 993 100.0

of 185

Table 157 Swelling over knee joint in Kolkata sample

Swelling over knee No of participants Percent

Never 240 24.2

Rarely 101 10.2

Sometimes 132 13.3


Always 59 5.9

Table 158 Grinding pain in knee in Kolkata sample

Grinding pain in knee No of participants Percent

Never 233 23.5

Rarely 142 14.3

Sometimes 153 15.4


Always 35 3.5

of 185

Table 159 Clicking pain in knee in Kolkata sample

Clicking pain in knee No of participants Percent

Never 180 18.1

Rarely 125 12.6

Sometimes 222 22.4


Always 35 3.5

Table 160 Catch up pain in knee in Kolkata sample

Catch up in knee No of participants Percent

Never 128 12.9

Rarely 114 11.5

Sometimes 272 27.4


Always 39 3.9

Table 161 stiffness in knee joint in Kolkata sample

Stiffness in knee No of participants Percent

Stiffness 267 26.9

No stiffness 379 38.2

of 185


Table 162 Prevalence of OA in Kolkata

OA status No of participants Percent

No OA 668 67.3

OA 325 32.7

Total 993 100.0

Figure 91 Prevalence of OA in Kolkata

of 185

Table 163 Prevalence of OA by gender

OA Status Sex of the respondent

Total Male Female

No OA Numbers 203 337 540

Prevalence 37.6 62.4 100.0


Prevalence 36.6 63.4 100.0

Table 164 Site-wise Prevalence of OA

OA status Site


OA Numbers 107 50 54 114

Prevalence (%) 31.8 28.7 37.8 33.6

Figure 92: Site wise OA prevalence in Kolkata

of 185

Table 165 OA by Knee Involvement in Kolkata

Knee involvement No of participants Percent

Right Knee 296 29.8

Left knee 290 29.2

Both knees 269 27.1

Total 993 100.0

6.3 Associated factors for OA Table 166 Association of OA and Gender in Kolkata

OA status Sex of the respondent

P value Male Female



OA Numbers 116 201


Table 167 Association of OA and Age

OA Status Age Group

P value <50 50 to 59 60 to 69 >70 +

No OA Numbers 345 105 66 24 0.000

Prevalence (%) 63.9% 19.4% 12.2% 4.4%

OA Numbers 135 77 70 35

Prevalence (%) 42.6% 24.3% 22.1% 11.0%

of 185

Table 168 Association of OA and BMI

OA status BMI category

P Value Underweight Normal Overweight

No OA Numbers 43 281 156 0.02

Prevalence (%) 9.0 58.5 32.5


Prevalence (%) 9.8 48.4 41.8

Figure 93: Association of BMI and OA in Kolkata

of 185

Table 169 Association of OA and Occupation

OA Status Occupation Type

P value

Unemploye

d

Housewif

e

Daily wage

worker

salaried

employee

Petty

Business other

No OA Numbers 47 205 82 72 40 94 N.S

Prevalence (%) 8.7 38.0 15.2 13.3 7.4 17.4

OA Numbers 41 111 41 47 24 53

Prevalence (%) 12.9 35.0 12.9 14.8 7.6 16.7

Table 170 Association of OA and Physical activity level

OA Status

Sedentary Active

Physically

demanding P Value


Prevalence (%) 28.9 34.6 29.1


Prevalence (%) 37.9 27.4 26.8

Table 171 Association of OA and toilet type

OA Status Type of Toilet

P value Indian Western Both

No OA Numbers 483 49 8 0.05

Prevalence (%) 89.4 9.1 1.5

OA Numbers 271 44 2

Prevalence (%) 85.5 13.9 .6

of 185

Table 172 Association of OA and Exercise

OA Status Exercise No Exercise P Value



OA Numbers 74 238


Table 173 Association of OA and Tobacco

OA Status Tobacco Users No Tobacco P value



OA Numbers 98 212


Table 174 Association of OA and Smoking




OA Numbers 260 57


of 185

Table 175 Association of OA and Alcohol

OA Status Alcohol

Consumption No Alcohol P value


Prevalence (%) 5.0 95

OA Numbers 12 305


of 185

Chapter 7 Karnataka State Analysis

(Site – Bangalore)

Table 176 Distribution of sample by Gender in Bangalore

Gender No of Participants Percent

Male 483 48.1

Female 522 51.9

Total 1005 100.0

Figure 94 Gender Distribution of Sample in Bangalore

Table 177 Site-wise Distribution of Population in Bangalore

Site No of Participants Percent

Big city 390 38.8

Small city 234 23.3

Town 198 19.7

Village 183 18.2

Total 1005 100.0

of 185

Figure 95 Site wise distribution of sample in Bangalore

Table 178 Distribution of population by Age group

Age Group No of Participants Percent

<50 years 400 39.8

50 to 59 years 197 19.6

60 to 69 years 254 25.3

>70 + years 154 15.3

Total 1005 100.0

of 185

Figure 96 Distribution of population by Age group

Table 179 Occupational status of population in Bangalore


Unemployed 136 13.5

Housewife 281 28.0




other 160 15.9

Total 1005 100.0

39.8

19.6 25.3 15.3

0

10

20

30

40

50

60

70

<50 50 to 59 60 to 69 >70 +

Pe

rce

nt

Age group

of 185

Figure 97 Occupational status of population

Table 180 Educational status of population

Educational status No of Participants Percent

Illiterate 540 53.7

1st To 10th Std. 376 37.4



Other 5 .5

Total 1005 100.0

13.5

28 36.5

3.6 2.5

15.9

0

10

20

30

40

50

60

70

Pe

rce

nta

ge

of 185

Figure 98 Educational status of population

Table 181 People with diabetes

Diabetes status No of Participants Percent

Diabetes 146 14.5

No diabetes 859 85.5

Total 1005 100.0

Table 182 people with hypertension

Hypertension No of Participants Percent

HTN 135 13.4

No HTN 870 86.6

Total 1005 100.0

53.7

37.4

4.4 4 0.5 0

10

20

30

40

50

60

70

80

90

Illiterate 1st To 10thStd.

11th &12thStd./

Diploma

Graduate &above

Other

Pe

rce

nt

of 185

Table 183 people with coronary artery disease

Coronary artery disease No of Participants Percent

Yes 18 1.8

No 987 97.9

Total 1005 100.0

Table 184 Tobacco Use in Bangalore

Tobacco No of Participants Percent

Tobacco Users 193 19.2

No Tobacco 812 80.8

Total 1005 100.0

Table 185 Tobacco Use pattern in Bangalore Sample

Tobacco use pattern No of Participants Percent

Smoking 122 12.1

Chewing 61 6.1

of 185

Table 186 Alcohol status of population in Bangalore Sample

Alcohol status Frequency Percent

Alcohol 916 91.1

No alcohol 89 8.9

Total 1005 100.0

Table 187 Physical activity of population in Bangalore Sample

Physical activity No of Participants Percent

Sedentary 257 25.6

Active 717 71.3


Table 188 Physical stress level of population in Bangalore Sample

Physical stress level No of Participants Percent

None 47 4.7

Very low 136 13.5

Low 388 38.6

High 403 40.1

Very high 31 3.1

Total 1005 100.0

of 185

Table 189 Type of toilet use by population in Bangalore Sample

Type of toilet No of Participants Percent

Indian 964 95.9

Western 39 3.9

Both 2 .2

Total 1005 100.0

Table 190 Exercise status of population in Bangalore Sample

Exercise status No of Participants Percent

Exercise 66 6.6


Total 1005 100.0

Table 191 Commonly Used Work Positions In Bangalore

Work Position No. %

Squatting 138 13.7


Kneeling 119 11.8

Bending 149 14.8



of 185

Figure 99 Commonly Used Work Positions In Bangalore (%)

of 185

Table 192 Positions Used For Food Preparation In Bangalore


Squatting 28 2.8


Kneeling 68 6.8

Bending 73 7.3

Standing 355 35.5


Figure 100 Positions Used For Food Preparation In Bangalore (%)

Table 193 Positions Used For Sweeping in Bangalore

Sweeping No %

Squatting 41 4.1

Kneeling 118 11.8

Bending 283 28.3

Standing 143 14.3


of 185

Figure 101 Positions Used For Sweeping in Bangalore (%)

Table 194 Positions Used For Mopping In Bangalore

Mopping No %

Squatting 68 6.8

Kneeling 105 10.5

Bending 229 22.9

Standing 157 15.7

Don’t mop 369 36.9

of 185

Figure 102 Positions Used For Mopping In Bangalore (%)

Table 195 Positions Used For Religious Activities In Bangalore


Squatting 35 3.5

Cross legged Sitting 190 19

Kneeling 117 11.7

Bending 191 19.1

Standing 381 38.1


Figure 103 Positions Used For Religious Activities In Bangalore (%)

of 185

7.1 Prevalence of Symptoms

Table 196 Knee pain status in last 5 years in Bangalore Sample

Knee pain status in last 5 yrs No of Participants Percent

Knee pain 635 63.2

No Knee pain 370 36.8

Total 1005 100.0

Table 197 Knee pain status in last 3 months

Knee pain status in last 3 months No of Participants Percent

Knee pain 35 3.5

No Knee pain 970 59.6

Total 1005 100.0

of 185

Table 198 Swelling of knee joint


Table 199 Prevalence of OA in Bangalore

OA Status No of Participants Percent

No OA 738 73.4

OA 267 26.6

Total 1005 100.0

Swelling over Knee No of Participants Percent

Never 973 .3

Rarely 13 1.3

Sometimes 15 1.5

Most times 1 .1

Always 3 .3

Total 1005 100.0

of 185

Figure 104: Knee OA prevalence in Bangalore



Total Male Female


Prevalence (%) 49.2 50.8 100.0


Prevalence (%) 45.3 54.7 100.0

of 185

Figure 105 Prevalence of OA by gender

Table 201 Site wise prevalence of OA

OA status Big city Small city Town Village Total

No OA Numbers 290 150 133 153 726

Prevalence (%) 39.9 20.7 18.3 21.1 100.0

OA Numbers 92 82 63 30 267

Prevalence (%) 34.5 30.7 23.6 11.2 100.0

Figure 106 Site wise prevalence of OA

49.2 50.8

45.3 54.7

0%

20%

40%

60%

80%

100%

Male Female

Pe

rce

nta

ge

NO OA OA

34.5 30.7

23.6

11.2

0

10

20

30

40

50

60

70

80

90


Pre

vale

nce

of 185

Table 202 Prevalence of OA by knee Involvement

Knee Involvement No of Participants Percent

RT Knee 239 23.8

LT Knee 239 23.8

Both Knee 214 21.3

7.3 Associated factors for OA Table 203 Prevalence of OA By gender


P value Male Female



OA Numbers 121 146


Table 204 Association of OA with age category

OA status Age group

P value <50 50 to 59 60 to 69 >70 +

No OA Numbers 339 146 156 85 0.00

Prevalence (%) 46.7 20.1 21.5 11.7

OA Numbers 55 49 95 68

Prevalence (%) 20.6 18.4 35.6 25.5

of 185

Table 205 Association of BMI with OA

OA status BMI category

P value Underweight Normal BMI Overweight


Prevalence (%) 8.6 50.3 41.1


Prevalence (%) 12.0 44.0 44.0

Table 206 Association of occupation with OA

OA Status

Unemploye

d Housewife

Daily

wage

worker

Salaried

employee

Petty

Busines

s other

P

value

No OA Numbers 91 198 280 33 17 107 0.12

Prevalence (%) 12.5 27.3 38.6 4.5 2.3 14.7

OA Numbers 44 80 82 3 8 50

Prevalence (%) 16.5 30.0 30.7 1.1 3.0 18.7

Table 207 Association of physical activity with OA

OA status

Sedentary Active

Physically

demanding P value

No OA Numbers 188 516 15 N .S

Prevalence (%) 25.9 71.1 2.1

OA Numbers 69 189 6

Prevalence (%) 25.8 70.8 2.2

of 185

Table 208 Association of type of Toilet use with OA

OA status Indian Western Both P value


Prevalence (%) 96.3 3.4 .3

OA Numbers 253 14 0

Prevalence (%) 94.8 5.2 .0

Table 209 Association of exercise with OA

OA status Exercise No Exercise P value



OA Numbers 22 245


Table 210 Association of type of Tobacco use with OA

OA Status Tobacco No Tobacco P value

No OA Numbers 154 572 0.057


OA Numbers 39 228


of 185

Table 211 Association of smoking use with OA




OA Numbers 247 20


Table 212 Association of Alcohol consumption with OA

OA Status Alcohol

consumption No Alcohol P value



OA Numbers 13 254


of 185

Chapter 8 Uttarakhand State Analysis

(Site: Dehradun)

Table 213 Distribution of population by gender

Gender No of participants Percent

Male 297 32.6

Female 615 67.4

Total 912 100.0

Figure 107: Gender Distribution in Dehradun Sample

of 185

Table 214 Site –wise distribution of sample

Site No of participants Percent

Big city 287 31.5

Small city 110 12.1

Town 106 11.6

Village 409 44.8

Total 912 100.0

Figure 108 Site wise Distribution in Dehradun

of 185

Table 215 Distribution of sample by age group

Age group No of participants Percent

<50 years 443 48.6

50 to 59 years 142 15.6

60 to 69 years 219 24.0

>70 + years 108 11.8

Total 912 100.0

Figure 109 Age Distribution in Dehradun

of 185

Table 216 Occupation status of population

Occupation No of participants Percent

Unemployed 17 1.9

Housewife 475 52.1




Other 74 8.1

Total 912 100.0

Figure 110: Occupation Distribution in Dehradun

of 185

Table 217 Educational status of Dehradun Sample

Education status No of participants Percent

Illiterate 563 61.7

1st To 10th Std. 246 27.0



Other 1 .1

Total 912 100.0

Table 218 Diabetic status of Dehradun Sample

Diabetes Status No of participants Percent

Diabetes 85 9.3

No Diabetes 827 87.1

Total 912 100.0

Table 219 Hypertension Status of Dehradun Sample


HTN 390 42.8

No HTN 522 57.2

Total 912 100.0

of 185

Table 220 Coronary Artery of Dehradun Sample

Coronary Artery Disease No of participants Percent

CAD 41 4.5

No CAD 871 95.4

Total 912 100.0

Table 221 Tobacco Users

Tobacco No of participants Percent

Tobacco users 331 36.3

No Tobacco 581 63.7

Total 912 100.0

Table 222 Tobacco use pattern

Tobacco use pattern No of participants Percent

Smoking 186 20.4

Chewing 171 18.4

Applied Mishri 8 .9

Table 223 Alcohol status

Alcohol status No of participants Percent

No alcohol consumption 822 90.1


Total 912 100.0

of 185

Table 224 Type of physical activity

Type of physical activity No of participants Percent

Sedentary 253 27.7

Active 617 67.7


Table 225 Level of physical stress

Physical stress No of participants Percent

None 209 22.9

Very low 298 32.7

Low 308 33.8

High 89 9.8

very high 8 .9

Total 912 100.0

Table 226 Common Work Positions Used In Dehradun

Work Position No. %

Squatting 698 76.5


Kneeling 47 5.2

Bending 296 32.5



of 185

Figure 111 Common Work Positions Used In Dehradun (%)

Table 227 Positions Used For Food Preparation In Dehradun


Squatting 248 27.2


Kneeling 6 0.7

Bending 21 2.3

Standing 274 30


of 185

Figure 112 Positions Used For Food Preparation In Dehradun (%)

Table 228 Positions Used For Sweeping In Dehradun

Sweeping No %

Squatting 351 38.5

Kneeling 257 28.2

Bending 7 0.8

Standing 61 6.7


of 185

Figure 113 Positions Used For Sweeping In Dehradun (%)

Table 229 Positions Used For Mopping In Dehradun

Mopping No %

Squatting 392 43

Kneeling 4 0.4

Bending 77 8.4

Standing 50 5.5

Don’t mop 442 48.5

of 185

Figure 114 Positions Used For Mopping In Dehradun (%)

Table 230 Positions Used For Religious Activities In Dehradun


Squatting 411 45.1

Cross legged Sitting 292 32

Kneeling 21 2.3

Bending 268 29.4

Standing 274 30


of 185

Figure 115 Positions Used For Religious Activities In Dehradun (%)

Table 231 Type of toilet use

Type of toilet No of participants Percent

Indian 859 94.2

Western 23 2.5

Both 30 3.3

Total 912 100.0

Table 232 Exercise status


Exercise 134 14.7


Total 912 100.0

of 185

8.1 Prevalence of Symptoms

Table 233 Knee pain status in last 5 years

Knee pain status in last 5 years No of participants Percent

Knee pain 821 90.1

No knee pain 91 9.9

Total 912 100.0

Table 234 Knee pain status in last 3 months

Knee pain status in last 3 months No of participants Percent

Knee pain 684 75.0

No knee pain 228 25.0

Total 912 100.0

Table 235 swelling of knee joint

Swelling over knee No of participants Percent

Never 482 52.8

Rarely 144 15.8

Sometimes 214 23.5


Always 15 1.6

of 185

Table 236 Grinding pain In knee joint

Grinding pain in knee No of participants Percent

Never 412 45.2

Rarely 175 19.2

Sometimes 236 25.9


Always 4 .4

Table 237 clicking pain in knee

Clicking pain in knee No of participants Percent

Never 342 37.5

Rarely 142 15.6

Sometimes 266 29.2


Always 15 1.6

Table 238 catch pain in knee

Catch in knee joint No of participants Percent

Never 534 57.5

Rarely 195 21.4

Sometimes 144 15.8


Always 10 1.1

of 185

Table 239 stiffness in knee joint

Stiffness No of participants Percent

Stiffness 546 59.9

No Stiffness 366 40.1

Total 912 100.0

8.2 Prevalence of Knee OA by Radiological Diagnosis

Table 240 Prevalence of OA in Dehradun

OA status No of participants Percent

No OA 665 72.9

OA 247 27.1

Total 912 100.0

Figure 116 Prevalence of Knee OA in Dehradun

of 185


OA status Male Female Total


Prevalence (%) 34.9 65.1 100.0


Prevalence (%) 26.3 73.7 100.0

Table 242 site-wise prevalence of OA

OA status Big

city Small city Town Village Total

OA Numbers 83 34 18 112 247

Prevalence (%) 33.6 13.8 7.3 45.3 100.0

Figure 117 Site wise Prevalence of OA knees in Dehradun (%)

of 185

Table 243 Prevalence by knee joint involvement

Knee Involvement No of participants Percent

RT Knee 218 23.9

LT Knee 186 20.4

Both Knee 151 16.6

of 185

8.3 Associated factors in Dehradun

Table 244 Association of gender and OA


P value Male Female



OA Numbers 65 182


Table 245 Association of Age and OA

OA Status Age category

P value <50 50 to 59 60 to 69 >70 +

No OA Numbers 375 106 131 52 0.000

Prevalence (%) 56.5 16.0 19.7 7.8

OA Numbers 68 36 88 55

Prevalence (%) 27.5 14.6 35.6 22.3

Figure 118: Association of Age and OA Knees in Dehradun

of 185

Table 246 Association of BMI and OA

OA status Underweight Normal BMI Overweight P value


Prevalence (%) 12.8 49.9 37.3


Prevalence (%) 8.9 51.0 40.1

Table 247 Association of OA and Occupation

OA status Unemploye

d

Housewif

e Laborer Salaried Business P value

No OA Numbers 11 338 166 68 31 0.010

Prevalence

(%)

1.7 50.9 25.0 10.2 4.7

OA Numbers 6 137 36 36 8

Prevalence

(%)

2.4 55.5 14.6 14.6 3.2

of 185

Figure 119: Association of Occupation and OA in Dehradun

Table 248 Association of OA and Physical activity level

OA Status

Sedentary Active

Physically

demanding P value


Prevalence (%) 26.2 68.7 4.5

OA Numbers 80 160 7

Prevalence (%) 32.0 64.8 2.4

of 185

Table 249 Association of OA knees and Toilet Type in Dehradun

OA Status Indian Western Both P value


Prevalence (%) 94.9 2.4 2.7

OA Numbers 228 7 12

Prevalence (%) 92.3 2.8 4.9

Table 250 Association of OA and Exercise in Dehradun

OA status

Exercise

No

exercise P Value



OA Numbers 39 208


Table 251Association of OA and Tobacco habits in Dehradun

OA Status Tobacco No Tobacco P value



OA Numbers 87 160


of 185

Chapter 9 Conclusion

The study used radiographic diagnosis for confirmation of knee Osteo Arthritis. The K-L

grade of OA grading was used for the same. The present study shows a prevalence of

28.7% in the overall sample. This varies slightly in the individual states where the study

was conducted – Agra (35.5%), Bangalore (26.6%), Kolkata (33.7%), Dehradun

(27.2%), and Pune (21.7%).

The prevalence was higher in villages (31.1%) and big cities (33.1%) as compared to

town (17.1%) and small cities (17.2%).

The association of gender and OA of this study are in congruence with available

literature on Knee Osteo-Arthritis. OA of the knees was found to be more prevalent in

females (31.6%) than in males (28.1%). This finding is statistically significant (p value

0.007)

The study found that prevalence of OA knees increased with increase in BMI. Knee OA

prevalence was significantly low in underweight people (28%) as compared to normal

weight and obese participants (33%). Prevalence was found to be highest in people who

are overweight and/or obese.

Our study findings are in line with the proven fact that the chances of OA increase with

Age. The prevalence was highest in among the age group of 60 and above, and lowest

in people in the age group of 40-50 years.

The prevalence of Knee OA was highest in participants who are unemployed. Although

statistically significant (p value 0.000), a cause-effect relationship cannot be derived.

This is so because the ‘unemployed group’ may include people who were retired. In

such cases, the OA may have been due to age rather than being unemployed.

Prevalence was lowest among participants who worked as daily wage workers /laborers

(22.2%).

Prevalence was highest in participants who have a sedentary lifestyle followed by

participants with a physically demanding lifestyle and active lifestyle. This difference was

statistically significant (p value 0.001) showing that OA prevalence was lowest in

participants who had a fairly active physical activity level. Since the study recorded the

current level of physical activity, it may be possible that geriatric participants were

of 185

included in the sedentary group. In those cases, the possibility of having OA may be

more due to age rather than lifestyle. Moreover, people with severe OA may have

changed their lifestyle.

OA prevalence was found to be significantly more (p value 0.000) in participants who

used western toilet (42.1%) as compared to those who used Indian toilet (29.7%) or both

types (38.8%).

Prevalence was higher in participants who do not Exercise (82.9%) compared to

participants who exercise (36). Although the questionnaire gathered information on type

of exercises done, there was not a significant difference in prevalence of OA among

different exercise groups.

of 185

Chapter 10 Recommendations

This study has evidenced a large percentage of sub-threshold population. i.e. K-L grade

1 which is considered as border-line or doubt-full as far as OA diagnosis.

This needs to be addressed. Awareness programme should be initiated at community

level which is needed for prevention of OA of knees as early age.

Prognosis would like to suggest that a longitudinal cohort study can be planned which

will in long run will prove impact of physical activity, habits and lifestyles

Stress on early diagnosis on onset of symptoms should be encouraged among the

general population.

Studies to understand how many people with symptoms of OA seek medical advice are

required, to understand the treatment seeking behavior and pain tolerance associated

with OA.

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