Disease burden trends of site-specific osteoarthritis in China from 1990 to 2023 and the attribution to high body mass index_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIONG Qianjiang ^1,2 , HU Lin ³ ^{共同第一作者} , HU Yunan ^1,2 , LIU Qingsong ^1,2 , LI Jian ^1,2 ,  YANG Chunxia ³ ,  FU Weili ^1,2

1. Sports Medicine Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
3. Department of Epidemiology and Health Statistics, West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

YANG Chunxia, Email: yangchunxia@scu.edu.cn; FU Weili, Email: foxwin2008@163.com

Keywords：

Osteoarthritis; high body mass index; disease burden; site-specific heterogeneity; trend analysis

DOI：

10.7507/1002-1892.202601051

Video：

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Objective To analyze the current status and temporal trends of the disease burden of osteoarthritis (OA) in China from 1990 to 2023, stratified by anatomical sites (knee, hip, hand, and other), utilizing data from the 2023 Global Burden of Disease (GBD) study, and to explore the site-specific heterogeneity of disease burden attributed to high body mass index (BMI), providing a scientific basis for formulating precision prevention and control strategies.Methods Based on the GBD 2023 database, data on the incidence, prevalence, and years lived with disability (YLDs), as well as their corresponding age-standardized rates of OA in China from 1990 to 2023, were collected and stratified by gender, age, and anatomical site (knee, hip, hand, and other). A log-linear regression model was employed to calculate the estimated annual percentage change (EAPC) to analyze temporal trends. Additionally, the population attributable fraction (PAF) was used to quantify the contribution of high BMI to OA across different sites and to analyze the heterogeneity of this attribution. Results In 2023, the disease burden of OA in China increased. In terms of anatomical distribution, knee OA constituted the heaviest burden, with 115.0032 million prevalent cases, accounting for approximately 65.78% of the total. Attribution analysis showed that knee OA was slightly more affected by high BMI than hip OA, and the PAF increased significantly over time. In 2023, the PAFs for knee and hip OA in females (29.49% and 28.57%, respectively) were substantially higher than those in 1990 (19.10% and 18.38%). A similar upward trend was observed in males (26.65% and 25.92% in 2023). Regarding attribution differences, female PAF levels were consistently higher than those of males across all years and sites. Hand OA exhibited the fastest growth rate, with the EAPC of its age-standardized YLDs rate reaching 1.64%, far exceeding that of knee OA (0.43%). Demographically, all burden indicators were higher in females than in males. Hand OA demonstrated an intergenerational cumulative effect. The difference in YLDs rates between 2023 and 1990 widened with age, reaching 123.29 per 100 000 in the >95 years old group, highlighting the severe challenges posed by population aging. Conclusion From 1990 to 2023, the disease burden of OA in China continued to rise. Knee OA remains the heaviest burden category and is significantly driven by high BMI, whereas hand OA shows the fastest growth trend. Prevention and control strategies should focus on weight management for knee and hip OA, while prioritizing the prevention and care of hand OA in the elderly population.

Citation： XIONG Qianjiang, HU Lin, HU Yunan, LIU Qingsong, LI Jian, YANG Chunxia, FU Weili. Disease burden trends of site-specific osteoarthritis in China from 1990 to 2023 and the attribution to high body mass index. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(3): 369-377. doi: 10.7507/1002-1892.202601051 Copy

1.	GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990—2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol, 2023, 5(9): e508-e522.
2.	吳昊天, 林劍浩. 骨關節炎疾病負擔與危害. 協和醫學雜志, 2025, 16(1): 5-12.
3.	陳興超, 高振華, 徐生剛, 等. 1990—2021年全球和中國及不同社會人口學指數地區骨關節炎疾病負擔趨勢分析. 中國全科醫學, 2025, 28(17): 2172-2178.
4.	Sobieh BH, El-Mesallamy HO, Kassem DH. Beyond mechanical loading: The metabolic contribution of obesity in osteoarthritis unveils novel therapeutic targets. Heliyon, 2023, 9(5): e15700. doi: 10.1016/j.heliyon.2023.e15700.
5.	Wang X, Hunter D, Xu J, et al. Metabolic triggered inflammation in osteoarthritis. Osteoarthritis Cartilage, 2015, 23(1): 22-30.
6.	Shumnalieva R, Kotov G, Monov S. Obesity-related knee osteoarthritis-current concepts. Life (Basel), 2023, 13(8): 1650. doi: 10.3390/life13081650.
7.	Reyes C, Leyland KM, Peat G, et al. Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: A population-based cohort study. Arthritis Rheumatol, 2016, 68(8): 1869-1875.
8.	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990—2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
9.	GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990—2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet, 2025, 406(10513): 1873-1922.
10.	Wang X, Huang J, Hu J, et al. Global burden, trends and forecast analysis of extremity fractures based on GBD 2021. Int J Surg, 2025, 111(7): 4884-4897.
11.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990—2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
12.	國家統計局. 第七次全國人口普查公報 (第五號)——人口年齡構成情況 [EB/OL]. (2021-05-11)[2025-12-29]. https://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/202302/t20230206_1902005.html.
13.	Monda KL, Gordon-Larsen P, Stevens J, et al. China’s transition: the effect of rapid urbanization on adult occupational physical activity. Soc Sci Med, 2007, 64(4): 858-870.
14.	Attard SM, Howard AG, Herring AH, et al. Differential associations of urbanicity and income with physical activity in adults in urbanizing China: findings from the population-based China Health and Nutrition Survey 1991—2009. Int J Behav Nutr Phys Act, 2015, 12: 152. doi: 10.1186/s12966-015-0321-2.
15.	Tangtrakulwanich B, Chongsuvivatwong V, Geater AF. Habitual floor activities increase risk of knee osteoarthritis. Clin Orthop Relat Res, 2007, 454: 147-154.
16.	Dahaghin S, Tehrani-Banihashemi SA, Faezi ST, et al. Squatting, sitting on the floor, or cycling: are life-long daily activities risk factors for clinical knee osteoarthritis? Stage Ⅲ results of a community-based study. Arthritis Rheum, 2009, 61(10): 1337-1342.
17.	Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021, 398(10294): 53-63.
18.	Chen K, Shen Z, Gu W, et al. Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults. Diabetes Obes Metab, 2023, 25(11): 3390-3399.
19.	Messier SP, Beavers DP, Loeser RF, et al. Knee joint loading in knee osteoarthritis: influence of abdominal and thigh fat. Med Sci Sports Exerc, 2014, 46(9): 1677-1683.
20.	Kalichman L, Hernández-Molina G. Hand osteoarthritis: an epidemiological perspective. Semin Arthritis Rheum, 2010, 39(6): 465-476.
21.	Choi K, Park JH, Cheong HK. Prevalence of musculoskeletal symptoms related with activities of daily living and contributing factors in Korean adults. J Prev Med Public Health, 2013, 46(1): 39-49.
22.	Loeser RF. Age-related changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med, 2010, 26(3): 371-386.
23.	Martel-Pelletier J, Barr AJ, Cicuttini FM, et al. Osteoarthritis. Nat Rev Dis Primers, 2016, 2: 16072. doi: 10.1038/nrdp.2016.72.
24.	Ouyang Y, Dai M. Global, regional, and national burden of knee osteoarthritis: findings from the Global Burden of Disease study 2021 and projections to 2045. J Orthop Surg Res, 2025, 20(1): 766. doi: 10.1186/s13018-025-06140-0.
25.	Eckstein F, Putz R, Wirth W. Sexual dimorphism in peri-articular tissue anatomy—More keys to understanding sex-differences in osteoarthritis? Osteoarthr Cartil Open, 2024, 6(3): 100485. doi: 10.1016/j.ocarto.2024.100485.
26.	Peshkova M, Lychagin A, Lipina M, et al. Gender-related aspects in osteoarthritis development and progression: A review. Int J Mol Sci, 2022, 23(5): 2767. doi: 10.3390/ijms23052767.
27.	Wang T, He C. Pro-inflammatory cytokines: The link between obesity and osteoarthritis. Cytokine Growth Factor Rev, 2018, 44: 38-50.
28.	King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res, 2013, 138(2): 185-193.
29.	Economou A, Mallia I, Fioravanti A, et al. The role of adipokines between genders in the pathogenesis of osteoarthritis. Int J Mol Sci, 2024, 25(19): 10865. doi: 10.3390/ijms251910865.

1. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990—2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol, 2023, 5(9): e508-e522.
2. 吳昊天, 林劍浩. 骨關節炎疾病負擔與危害. 協和醫學雜志, 2025, 16(1): 5-12.
3. 陳興超, 高振華, 徐生剛, 等. 1990—2021年全球和中國及不同社會人口學指數地區骨關節炎疾病負擔趨勢分析. 中國全科醫學, 2025, 28(17): 2172-2178.
4. Sobieh BH, El-Mesallamy HO, Kassem DH. Beyond mechanical loading: The metabolic contribution of obesity in osteoarthritis unveils novel therapeutic targets. Heliyon, 2023, 9(5): e15700. doi: 10.1016/j.heliyon.2023.e15700.
5. Wang X, Hunter D, Xu J, et al. Metabolic triggered inflammation in osteoarthritis. Osteoarthritis Cartilage, 2015, 23(1): 22-30.
6. Shumnalieva R, Kotov G, Monov S. Obesity-related knee osteoarthritis-current concepts. Life (Basel), 2023, 13(8): 1650. doi: 10.3390/life13081650.
7. Reyes C, Leyland KM, Peat G, et al. Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: A population-based cohort study. Arthritis Rheumatol, 2016, 68(8): 1869-1875.
8. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990—2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
9. GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990—2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet, 2025, 406(10513): 1873-1922.
10. Wang X, Huang J, Hu J, et al. Global burden, trends and forecast analysis of extremity fractures based on GBD 2021. Int J Surg, 2025, 111(7): 4884-4897.
11. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990—2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
12. 國家統計局. 第七次全國人口普查公報 (第五號)——人口年齡構成情況 [EB/OL]. (2021-05-11)[2025-12-29]. https://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/202302/t20230206_1902005.html.
13. Monda KL, Gordon-Larsen P, Stevens J, et al. China’s transition: the effect of rapid urbanization on adult occupational physical activity. Soc Sci Med, 2007, 64(4): 858-870.
14. Attard SM, Howard AG, Herring AH, et al. Differential associations of urbanicity and income with physical activity in adults in urbanizing China: findings from the population-based China Health and Nutrition Survey 1991—2009. Int J Behav Nutr Phys Act, 2015, 12: 152. doi: 10.1186/s12966-015-0321-2.
15. Tangtrakulwanich B, Chongsuvivatwong V, Geater AF. Habitual floor activities increase risk of knee osteoarthritis. Clin Orthop Relat Res, 2007, 454: 147-154.
16. Dahaghin S, Tehrani-Banihashemi SA, Faezi ST, et al. Squatting, sitting on the floor, or cycling: are life-long daily activities risk factors for clinical knee osteoarthritis? Stage Ⅲ results of a community-based study. Arthritis Rheum, 2009, 61(10): 1337-1342.
17. Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021, 398(10294): 53-63.
18. Chen K, Shen Z, Gu W, et al. Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults. Diabetes Obes Metab, 2023, 25(11): 3390-3399.
19. Messier SP, Beavers DP, Loeser RF, et al. Knee joint loading in knee osteoarthritis: influence of abdominal and thigh fat. Med Sci Sports Exerc, 2014, 46(9): 1677-1683.
20. Kalichman L, Hernández-Molina G. Hand osteoarthritis: an epidemiological perspective. Semin Arthritis Rheum, 2010, 39(6): 465-476.
21. Choi K, Park JH, Cheong HK. Prevalence of musculoskeletal symptoms related with activities of daily living and contributing factors in Korean adults. J Prev Med Public Health, 2013, 46(1): 39-49.
22. Loeser RF. Age-related changes in the musculoskeletal system and the development of osteoarthritis. Clin Geriatr Med, 2010, 26(3): 371-386.
23. Martel-Pelletier J, Barr AJ, Cicuttini FM, et al. Osteoarthritis. Nat Rev Dis Primers, 2016, 2: 16072. doi: 10.1038/nrdp.2016.72.
24. Ouyang Y, Dai M. Global, regional, and national burden of knee osteoarthritis: findings from the Global Burden of Disease study 2021 and projections to 2045. J Orthop Surg Res, 2025, 20(1): 766. doi: 10.1186/s13018-025-06140-0.
25. Eckstein F, Putz R, Wirth W. Sexual dimorphism in peri-articular tissue anatomy—More keys to understanding sex-differences in osteoarthritis? Osteoarthr Cartil Open, 2024, 6(3): 100485. doi: 10.1016/j.ocarto.2024.100485.
26. Peshkova M, Lychagin A, Lipina M, et al. Gender-related aspects in osteoarthritis development and progression: A review. Int J Mol Sci, 2022, 23(5): 2767. doi: 10.3390/ijms23052767.
27. Wang T, He C. Pro-inflammatory cytokines: The link between obesity and osteoarthritis. Cytokine Growth Factor Rev, 2018, 44: 38-50.
28. King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res, 2013, 138(2): 185-193.
29. Economou A, Mallia I, Fioravanti A, et al. The role of adipokines between genders in the pathogenesis of osteoarthritis. Int J Mol Sci, 2024, 25(19): 10865. doi: 10.3390/ijms251910865.

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