We will use patients medical history data to investigate adhesive capsulitis or frozen shoulder disease. Our study will assess the associations between frozen shoulder and a number of conditions like cancer or diabetes, where previous studies suggest frozen shoulder could be an early symptom of disease. This information would be helpful to speed up diagnosis and hopefully improve the prognosis of some of these conditions like cancer.
We will also study how frozen shoulder is distributed across the UK in primary care practices and how it varies with region and socioeconomic status. By doing so we can estimate the geographical trends and the demographics of the people affected. This will provide us with a better understanding of who is likely to get the condition.
By confirming which other conditions frozen shoulder is commonly seen with, our knowledge of how those conditions happen may help us gain a better understanding of the body process that is causing the disease. This could ultimately inform new research and further the development of novel treatments.
We will conduct a cohort study looking at adhesive capsulitis through the interrogation of the CPRD database of primary care centres in the UK.
Objectives: 1.To measure the incidence of adhesive capsulitis, and to describe secular trends over time, and variation by UK region and socio-economic status;
2.To look at the association between adhesive capsulitis and the development of inflammatory conditions including diabetes, hypothyroidism, Dupuytrens, cancer, stroke, heart disease, pulmonary fibrosis, liver cirrhosis, atherosclerosis, gout, inflammatory tendon disorders, auto immune disease/s, inflammatory bowel disease, mental health diagnoses including dementia, and all-cause mortality
Population: Patients >18yo registered in the CRPD database that have a diagnosis of adhesive capsulitis/Frozen shoulder on their medical history and 1+ years of CPRD data available before diagnosis. They will be compared with a 1:5 age, sex and practice matched control cohort for Objective 2.
Exposure: diagnosis of frozen shoulder
Outcomes: Adhesive capsulitis, diabetes, hypothyroidism, Dupuytrens, cancer, stroke, heart disease, pulmonary fibrosis, liver cirrhosis, atherosclerosis, gout, inflammatory tendon disorders, auto immune disease/s, inflammatory bowel disease, mental health diagnoses including dementia, and all-cause mortality
Analyses: Incidence and prevalence rates of adhesive capsulitis will be measured overall and stratified by time (calendar year), region, and Index of Multiple Deprivation (IMD) quintile.
Using CPRD and linked HES data we will investigate which of these patients remain with their primary care physician and who is referred on, as well as how this varies according to region as well.
Finally, multivariable Cox models stratified by matched sets will be used to calculate adjusted Hazards Ratios for each outcome according to the presence/absence of adhesive capsulitis.
Through this analysis we can confirm or disprove previous associations the disease has been shown to have with other conditions and investigate novel relationships to other fibrotic and inflammatory conditions that have been theorized.
Primary or secondary care diagnosis of adhesive capsulitis.
Associated diseases or conditions as suggested by previous literature: diabetes, hypothyroidism, cancer, stroke, heart disease.
Diseases associated with chronic inflammation: pulmonary fibrosis, liver cirrhosis, atherosclerosis, inflammatory tendon disorders, auto immune disease/s, inflammatory bowel disease, mental health diagnoses including dementia, and all-cause mortality.
Daniel Prieto-Alhambra - Chief Investigator - University of Oxford
Daniel Prieto-Alhambra - Corresponding Applicant - University of Oxford
Andrew Carr - Collaborator - University of Oxford
Antonella Delmestri - Collaborator - University of Oxford
Danielle Robinson - Collaborator - University of Oxford
Navraj Nagra - Collaborator - University of Oxford
Simon Hoy - Collaborator - University of Oxford
Stephanie Dakin - Collaborator - University of Oxford
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Practice Level Index of Multiple Deprivation