University of Oulu

Hallberg, Sara, Rolfson, Ola, Karppinen, Jaro, Schiøttz-Christensen, Berit, Stubhaug, Audun, Rivano Fischer, Marcelo, Gerdle, Björn, Toresson Grip, Emilie, Gustavsson, Anders, Robinson, Rebecca L, Varenhorst, Christoph and Schepman, Patricia. "Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study" Scandinavian Journal of Pain, vol. 23, no. 1, 2023, pp. 126-138.

Burden of disease and management of osteoarthritis and chronic low back pain : healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS) : study design and patient characteristics of a real world data study

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Author: Hallberg, Sara1; Rolfson, Ola2; Karppinen, Jaro3,4;
Organizations: 1Quantify Research, Stockholm, Sweden
2University of Gothenburg, Gothenburg, Sweden
3Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
4Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
5Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
6Department of Pain Management and Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
7Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
8Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
9Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
10Karolinska Institute, Stockholm, Sweden
11Eli Lilly & Co., Indianapolis, IN, USA
12Pfizer AB, Sollentuna, Sweden
13Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
14Pfizer Inc., New York, NY, USA
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
Persistent link:
Language: English
Published: De Gruyter, 2023
Publish Date: 2023-10-02


Objectives: Osteoarthritis (OA) and chronic low back pain (CLBP) are common musculoskeletal disorders with substantial patient and societal burden. Nordic administrative registers offer a unique opportunity to study the impact of these conditions in the real-world setting. The Burden of Disease and Management of Osteoarthritis and Chronic Low Back Pain: Health Care Utilization and Sick Leave in Sweden, Norway, Finland and Denmark (BISCUITS) study was designed to study disease prevalence and the societal and economic burden in broad OA and CLBP populations.

Methods: Patients in Sweden, Norway, Finland and Denmark with diagnoses of OA or CLBP (low back pain record plus ≥2 pain relief prescriptions to indicate chronicity) were identified in specialty care, in primary care (Sweden and Finland) and in a quality-of-care register (Sweden). Matched controls were identified for the specialty care cohort. Longitudinal data were extracted on prevalence, treatment patterns, patient-reported outcomes, social and economic burden.

Results: Almost 1.4 million patients with OA and 0.4 million with CLBP were identified in specialty care, corresponding to a prevalence in the Nordic countries of 6.3 and 1.9%, respectively. The prevalence increased to 11–14% for OA and almost 6% for CLBP when adding patients identified in primary care. OA patients had a higher Elixhauser comorbidity index (0.66 vs. 0.46) and were using opioids (44.7 vs. 10.2%) or long-term nonsteroidal anti-inflammatory drug (NSAIDs) (20.9 vs. 4.5%) more than four times as often as compared to controls. The differences were even larger for CLBP patients compared to their controls (comorbidity index 0.89 vs. 0.39, opioid use 77.7 vs. 9.4%, and long-term NSAID use 37.2 vs. 4.8%).

Conclusions: The BISCUITS study offers an unprecedented, longitudinal healthcare data source to quantify the real-world burden of more than 1.8 million patients with OA or CLBP across four countries. In subsequent papers we aim to explore among others additional outcomes and subgroups of patients, primarily those patients who may benefit most from better healthcare management.

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Series: Scandinavian journal of pain
ISSN: 1877-8860
ISSN-E: 1877-8879
ISSN-L: 1877-8860
Volume: 23
Issue: 1
DOI: 10.1515/sjpain-2021-0212
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: This study was sponsored by Pfizer and Eli Lilly & Company.
Copyright information: © 2022 Walter de Gruyter GmbH, Berlin/Boston.