Shoulder pain is a common complaint that can lead to sleeping difficulties, work disability and functional limitations in daily activities such as dressing and driving. It affects between 5% and 47% of the adult population annually worldwide. In the United Kingdom (UK), about 2.4% of people aged between 18 and 60 years old annually consult their general practitioners (GPs) for shoulder pain and the number of consultations in primary care for shoulder pain appears to be increasing. Shoulder pain increases with age and is higher in women than in men. However, whether the occurrence of shoulder pain has changed in the past 21 years in the UK, its variations between regions and its major consequences remain largely unknown.
From a population health perspective, having insight into the frequency of shoulder pain in the UK will help to understand the disease burden and the population at risk, and provide effective management for patients in primary care. Therefore, this research aims to investigate the current frequency of shoulder pain, the trend in the past 21 years, variation between different areas and related risk factors in the UK population.
This project aims to determine the prevalence and incidence, risk factors, and outcomes of shoulder pain from 2000 to 2020.
Prevalence and incidence rates in 2019 will be used to present the current disease burden as 2020 estimates may be unrepresentative due to the COVID pandemic. Age, sex and geographic distribution, and trends in prevalence and incidence from 2000-2020 will be examined. We will undertake a case-control study to examine risk factors. Incident cases of shoulder pain will be identified between 2000 and 2020 (first diagnosis date as index date). Each will be matched with a control without shoulder pain by age, sex, and practice at the index date. We will compare risk factors such as alcohol, smoking, body mass index (BMI), ethnicity and socioeconomic status between cases and controls by the index date retrospectively. A logistic regression model will be used to estimate odds ratios.
We will then undertake a cohort study to follow up the cases and controls from the index date for the outcomes of interest including number of general practitioner (GP) consultations and hospitalisations per year, comorbidities, and all-cause mortality. For comorbidity, people at risk of a specific comorbidity of interest will be followed up. For example, diabetes at the index date will be excluded in order to capture incident diabetes. The Cox regression model will be used for this analysis. Hospital episode statistics (HES) will be used to determine hospitalisations. Office for National Statistics (ONS) death registration data will be used for estimating all-cause mortality.
This research will increase understanding of the burden of shoulder pain in the UK, potential use of health resources because of shoulder pain and its comorbidities. It will also inform early intervention strategies for people at higher risk of comorbidity.
Primary outcomes :
1- The current prevalence and incidence of shoulder pain in the UK, overall, by age, sex, and regions. We will use 2019 data to present the current prevalence and incidence to avoid the bias due to the COVID-19 pandemic.
2- The risk factors associated with shoulder pain.
Secondary outcomes:
3- The outcomes of shoulder pain.
We will determine the number of GP consultations per year, the frequency of hospitalisations per year and all-cause mortality. We will also examine the incidence of comorbidities and their relative risk in people with shoulder pain versus those without.
4- Types of shoulder pain and their prevalence and incidence in 2019.
The prevalence of different diagnostic codes for shoulder pain in the year 2019 will be examined.
- The following pathoanatomical classification system of shoulder disorders has been widely used in clinical practice (1): rotator cuff; biceps tendon; adhesive capsulitis; glenohumeral arthritis; acromioclavicular joint abnormalities.
- A non–specific shoulder pain category is also frequently found in the general population and clinical practice due to the lack of a consistent standardised diagnostic approach for the shoulder (1).
- The diagnosis of shoulder disorders in the primary care (the Guidelines on referral and treatment ) in the NHS is described in Appendix 1
5- The trends of shoulder pain in the past 21 years (2000 – 2020)
We will report the prevalence and incidence each year and examine the trend from 2000 to 2020. We will include 2020 data to examine the impact of the pandemic/lockdown on shoulder pain.
Michelle Hall - Chief Investigator - University of Nottingham
Nouf Alotaibi - Corresponding Applicant - University of Nottingham
Barbara Iyen - Collaborator - University of Nottingham
Michael Doherty - Collaborator - University of Nottingham
Subhashisa Swain - Collaborator - University of Oxford
Weiya Zhang - Collaborator - University of Nottingham
Yana Vinogradova - Collaborator - University of Nottingham
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation