ArticleOsteoarthritis and cartilage open2026
Association of hypertension and diabetes with opioid initiation and progression to long-term use after osteoarthritis diagnosis: A population-based register cohort study in Sweden.
Article in Osteoarthritis and cartilage open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To estimate the associations of diabetes and/or hypertension with (i) initiating opioid therapy and (ii) progressing to long-term opioid use, after an osteoarthritis (OA) diagnosis. Methods: Population-based open cohort study using Swedish registers. We followed 48,778 opioid-naïve individuals, aged 35-75, with incident OA between 2008 and 2019 in the Skåne region. The associations of diabetes and hypertension with first opioid dispensation (ATC: N02A) and long-term opioid use (≥90 Defined Daily Doses in one year) were analysed using flexible parametric survival models. Associations were adjusted for sociodemographic characteristics, comorbidities, and prior healthcare use. Results: At OA diagnosis, 26% of individuals had hypertension alone, 3% diabetes alone, and 6% both; 3% developed diabetes during follow-up time, 8% hypertension. Compared to metabolically healthy individuals, the risk of a first opioid dispensation was higher only for those with hypertension alone (RR: 1.16 [95% CI 1.12; 1.20]) and both conditions (RR: 1.15 [1.10; 1.21]). All metabolic conditions were associated with a higher risk of long-term opioid use: diabetes alone (RR: 1.63 [1.21; 2.20]), hypertension alone (RR: 1.32 [1.14; 1.52]), and both (RR: 1.69 [1.42; 2.02]). The instant risk peaked in the first year post-diagnosis, and the cumulative risk was highest in comorbid groups for both outcomes (47.5% and 4.6% with both conditions vs 39.0% and 2.5% with none). Conclusion: After OA diagnosis, hypertension and/or diabetes were associated with an increased risk of initiating opioid therapy and progressing to long-term use. Our findings underscore the need to develop safer OA management strategies for individuals with comorbidities.
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