Traditional Chinese Medicine Reduces Hospitalization Risk of Osteoarthritis Patients: A 13- Year Population-based Cohort Study

doi:10.21203/rs.3.rs-962856/v1

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Traditional Chinese Medicine Reduces Hospitalization Risk of Osteoarthritis Patients: A 13- Year Population-based Cohort Study

https://doi.org/10.21203/rs.3.rs-962856/v1

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Introduction：Osteoarthritis (OA) is a chronic musculoskeletal disorder of the movable joints. TCM has been widely used as complementary therapy for OA in Chinese. Traditional Chinese medicine (TCM) including Duhuojishi decoction, Shujing Huoxue decoction, Angelica Niantong decoction, Guilu Erxian glue et al are widely used in the clinical of osteoarthritis treatment. However there are very few large-scale studies about long-term effect of TCM on OA treatment. This study determined the long-term effects of TCM on reducing OA patients hospitalization risk.

Material and methods: This study was a population-based retrospective cohort study. Patient data were collected from the claim-based Taiwan National Health Insurance Research Database from 2000 to 2012. We enrolled 67737 TCM treated cohort and 67737 non-TCM comparison of newly diagnosed OA patients. Propensity score matching was done on age, sex and possible confounders to ensure baseline comparability. Outcomes were medical utility, including hospitalization rate, emergency visits and direct medical expense. Logistic regression was conducted to compare the differences o between TCM and non-TCM groups. Subgroup analyses were also performed by age, gender, income and urbanization.

Results: TCM group had an overall higher medical expense than non-TCM group. Although Logistic regression analysis results showed that there was no difference of emergency rate in TCM group and non-TCM group, TCM treatment reduced hospitalization rate of OA significantly.

Conclusions: The usage of TCM was associated with a reduced risk of hospitalization of OA patients. TCM might play a complementary role in OA treatment.

Health Policy

Rheumatology

osteoarthritis

traditional Chinese medicine

medical utility

hospitalization risk

retrospective cohort study

Osteoarthritis (OA) is a chronic musculoskeletal disorder of the movable joints, such as hip and knee joint, which represents an extensive and increasing health burden for the patients and health care systems of society(1). With the increasing of ageing and obesity incidence in the global population, osteoarthritis affects around 250 million people around the world currently(2, 3). In the nowadays opinions, OA is a whole joint disease instead of only cartilage degeneration, which involve structural alterations in joint synovium, cartilage, subchondral bone, ligaments, capsule, and periarticular muscles(4, 5). Mechanical, inflammatory, and metabolic factors take part in the pathogenesis of OA , and lead to structural destruction of the joint(2, 6).

Although OA pharmacological treatment most often recommended in the guidelines are paracetamol and NSAIDs(7), while long-term use can increase the incidence of signiﬁcant adverse reactions, for example gastrointestinal bleeding, perforated ulcers, hepatic toxicity, and renal toxicity. Thus, natural production, especially traditional Chinese medicine (TCM), attracted wide attention in OA treatment. TCM has been recognized as a complementary therapy for OA patients, both in Asian (8, 9) and the West countries (10, 11) which might relieve pain, good for mobility and function as well as emotion(12). Currently, TCM, such as acupuncture moxibustion and Tai Chi, has been recommended by the OARSI guidelines and reviews for non-surgical management of OA(13-15). There were some researches showed that some TCM were good for OA, such as Jiawei Yanghe(16), Corydalis Rhizome(17, 18), Ligusticum chuanxiong(18, 19), Aconitum carmichaeli(18), Tougu Xiaotong capsules(20) et al, because of their function in cartilage protection, pain relief, invigorating blood circulation, down regulate inflammation and so on. However there are very few large-scale studies about long-term effect of TCM on OA treatment. This study aims to explore the long-term clinical effects of TCM usage on reducing the hospitalization risk of OA.

2.1 Data source

Data in this present population-based retrospective cohort study, were collected from the Longitudinal Health Insurance Database 2000 (LHID2000), which was openly available and contained 1 million sampled beneficiaries from the National Health Institutes Research Database (NHIRD) in 2000. NHIRD is created in 1995, and it is a population-based database which is a collection of medical information for more than 99% of Taiwan population, meanwhile it was divided into several small databases. This database contains all registrations and claims data of Taiwan patients, including diagnoses, inpatient care, outpatient visits, drug prescriptions and International Classification of diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes.

This study is approved by Ethics committee of Chun Shan Medical University (CSMUH No. CS17114). We confirm that all methods were performed in accordance with the relevant guidelines and regulations by including a statement in the methods section to this effect.

2.2 Study cohort identification

We selected OA patients from all the 1 million people in LHID 2000 from January 1, 2000 to December 31, 2012, as shown in the flow chart (Figure 1, n=125023). Patients with the first record of the ICD-9-CM code 715 in at least one inpatient claim or had three or more outpatient services were identified to be newly diagnosed as OA. To ensure that all patients in this study have a similar baseline disease stage, we excluded patients who diagnosed OA before 2000. Then we divided the patients into two groups, TCM and non-TCM, who had a usage of TCM more than 30 days within one year after diagnosis of OA (n=6806), and had never usage of any kind of TCM after diagnosis of OA respectively (n=40798). We also excluded patients whose age was younger than 20 in both group (n=69 and 409 respectively). Finely propensity score was matched 1:1 by age, sex, income, urbanization, hypertension, hyperlipidemia, Charlson comorbidity index, NSAIDs and diagnosis year of OA. The date of one year after OA diagnose was defined as the index date. The outcomes were one year medical utility, including hospitalization rate, emergency visits and direct medical expense after index date.

2.3 Exposure

Patients who have used TCM equal and more than 30 days within one year after diagnosis of OA were assigned to the TCM group, and patients who never use TCM after diagnosis of OA were enrolled to the non-TCM group. In this present study, TCM treatment is represent of 20 kinds of Chinese herbal medicine. First, we acquired all demographic characteristics of OA patients, for example, age, gender, monthly income, urbanization, medical expenses and so on. TCM is including Duhuojishi decoction, Shujing Huoxue decoction, Angelica Niantong decoction, Guilu Erxian glue, Jiawei Xiaoyao powder, Jisheng Shenqi pill, Shaoyao liquorice decoction, Shentong Zhuyu decoction, Xuefu Zhuyu decoction, maziren pill, Qiju Dihuang Wan, Xiangsha Liujunzi, Zhibai Dihuang Wan, Gegen Tang, Xiaohuoluo Dan Banxia Xiexin decoction, Tianwang buxindan, Guizhi shaoyaozhi, Liuwei Dihuang pill, and Zuogui pill.

2.4 Endpoints

Medical utilities including inpatient care, emergent visit and medical expenses are the endpoints of this study.

2.5 Covariates and matching

To reduce selection bias, the TCM group was 1:1 matched with the non-TCM group by propensity scores based on covariates and baseline characteristics, including age at diagnosis (20-40, 40-65 and ≥65 years), sex, monthly income (<NT$20000, NT$20000-NT$40000 and ≥NT$40000), urbanization, and comorbidities. Comorbidities such as hypertension (ICD-9-CM 401–405) and hyperlipidemia (ICD-9-CM 272.0–272.4) might influence the progress of OA. These comorbidities were defined within 1 year before the index date based on at least two outpatient visits or one hospitalization and were considered covariates in the multivariate analysis. The TCM and non-TCM group both comprised 6737 patients. Figure 1 displays the flowchart of the sample selection.

2.6 Statistical analysis

The Chi-square test and Student's t test were conducted to compare the distributed differences of demographic characteristics and comorbidities between TCM and non-TCM groups. The logistic regression was used to estimate the risk of emergency and hospitalization. The linear regression was used to estimate the risk of utility of medical expenses. Due to fit the normal distribution, the log transformation was used with the medical expenses. The statistical software used was SPSS (version 18.0; SPSS Inc., Chicago, IL, USA). Statistical significance was defined as a p of <0.05.

We enrolled 125023 patients newly diagnosed with OA, of whom 6806 were TCM users and 40798 were TCM non-users. Then we also excluded patients whose age was younger than 20 in both group (n=69 and 409 respectively). Finally, the TCM group was 1:1 matched with the non-TCM group by propensity scores based on covariates and baseline characteristics, including age at diagnosis, sex, monthly income, urbanization, and comorbidities as shown in Figure 1.

Table 1 shows the comparisons of the baseline demographic characteristics and comorbidities between TCM and non-TCM groups. Younger people much more accepted TCM treatment than older patients (p<0.001). The mean age at diagnosis was 56.6 years (SD 13.4 years) in the TCM group, which was younger than the non-TCM group (58.3 ± 14.1 years). While gender, monthly income, urbanization, and comorbidities had no difference in these two groups. TCM group had a higher medical expense than non-TCM group (p<0.001).

Logistic regression analysis results showed that there was no difference of emergency rate in TCM group and non-TCM group. While OA patients whose age between 20 to 40 (crude OR, 1.26; 95% CI, 1.09-1.46; adjust OR, 1.44; 95% CI, 1.24-1.67) and older than 65 (crude OR, 1.49; 95% CI, 1.35-1.63; adjust OR, 1.12; 95% CI, 1.01-1.25),who lived in rural (crude OR, 1.24; 95% CI, 1.07-1.44; adjust OR, 1.18; 95% CI, 1.01-1.37), combined with hypertension (crude OR, 1.51; 95% CI, 1.37-1.65; adjust OR, 1.23; 95% CI, 1.11-1.36), Charlson comorbidity index score 1 (crude OR, 1.78; 95% CI, 1.62-1.95; adjust OR, 1.65; 95% CI, 1.50-1.82), Charlson comorbidity index score 2 and more (crude OR, 2.39; 95% CI, 2.08-2.75; adjust OR, 2.12; 95% CI, 1.83-2.45), and who had a usage of NSAID (crude OR, 1.42; 95% CI, 1.29-1.57; adjust OR, 1.20; 95% CI, 1.08-1.33) had a significant higher risk of emergency treatment. OA patients whose income was more than NT$20000 had a significant lower risk of emergency (Table 2).

Another part results showed that TCM treatment (crude OR, 0.87; 95% CI, 0.79-0.96; adjust OR, 0.86; 95% CI, 0.78-0.95) reduced hospitalization risk of OA, as well as patients whose monthly income more than NT$20000. Similarly as results of Logistic regression analysis of emergency rate, older than 65 years (crude OR, 2.13; 95% CI, 1.92-2.36; adjust OR, 1.39; 95% CI, 1.24-1.56), lived in suburban (crude OR, 1.32; 95% CI, 1.19-1.47; adjust OR, 1.25; 95% CI, 1.12-1.4) or rural (crude OR, 1.40; 95% CI, 1.19-1.65; adjust OR, 1.24; 95% CI, 1.04-1.49), combined with hypertension (crude OR, 1.92; 95% CI, 1.73-2.13; adjust OR, 1.28; 95% CI, 1.14-1.43), Charlson comorbidity index score 1 (crude OR, 2.11; 95% CI, 1.89-2.35; adjust OR, 1.78; 95% CI, 1.59-2.00), Charlson comorbidity index score 2 and more (crude OR, 4.55; 95% CI, 3.93-5.28; adjust OR, 3.53; 95% CI, 3.02-4.13), and who had a usage of NSAID (crude OR, 2.02; 95% CI, 1.81-2.25; adjust OR, 1.55; 95% CI, 1.38-1.73) had a significant higher risk of hospitalization (Table 3).

We analyzed medical expenses of different subgroups. The results showed that TCM treatment might increase the medical expenses (crude beta, 0.78, SE, 0.03; adjusted beta, 0.78, SE, 0.03), at the same time, older patients (≥65 years) (crude beta, 0.46, SE, 0.04; adjusted beta, 0.11, SE, 0.04), combined with hypertension (crude beta, 0.93, SE, 0.04; adjusted beta, 0.53, SE, 0.04) or hyperlipidemia (crude beta, 0.82, SE, 0.05; adjusted beta, 0.41, SE, 0.05), Charlson comorbidity index score 1 (crude beta, 0.87, SE, 0.04; adjusted beta, 0.65, SE, 0.04), Charlson comorbidity index score 2 and more (crude OR, 1.20, SE, 0.06; adjusted beta, 0.87, SE, 0.06), and patients used NSAIDs (crude beta, 0.81, SE, 0.04; adjusted beta, 0.53, SE, 0.04) increase the medical expenses. While patients aged between 20 to 40 (crude beta, -0.49, SE, 0.06; adjusted beta, -0.23, SE, 0.06) and male(crude beta, -0.15 SE, 0.04) had a significant lower medical expenses (Table 4).

In this study, we found that TCM treatment reduced hospitalization rate of OA significantly (adjust OR, 0.86; 95% CI, 0.78-0.95).

OA is a kind of highly prevalent rheumatic musculoskeletal disorder. It affected more than 250 million people globally. It usually affects knees, hands, hips and spine. OA plays a significant impact on the individual and the society. It causes pain and disability of joints, and takes an important effect on the economic burden of individual and society. As it was described by Osteoarthritis Research Society International (OARSI) of a White Paper in 2016, osteoarthritis is a Serious Disease. NSAIDs, Paracetamol, corticosteroid and tramadol are prescribed to OA patients for symptom alleviation, which are recommended by different guidelines. As the increasing of cardiovascular risk, gastrointestinal risk and adverse on renal function, many patients may cannot adherent to long-term treatment.

TCM represents synthesis of ancient philosophy, art, culture and science(21-23). According to the theory of TCM, Yin-Yang and Five-Element can describe everything in the whole cosmos(24, 25). Different from Western medicine’s organ systems and disease classiﬁcation, TCM defined human body, organs and systems as a uniform(26, 27). TCM has been accepted as a kind of complementary treatment method for OA, both in Asian and the West countries which might relieve pain, good for mobility and function as well as emotion. TCM emphasizes the individualization of pain conditions based on body balance and mind–body interaction(23). The present aimed at using a nationwide database to explore the long-term efﬁcacy of TCM treatment in OA patients. The results of this study showed that the usage of TCM could reduce the OA patients’ hospitalization risk.

TCM relief symptom of OA from different aspects. It was reported that Corydalis Rhizome(17, 18), Ligusticum chuanxiong(18, 19), Aconitum carmichaeli(18), Tougu Xiaotong capsules(20) have function in cartilage protection, pain relief, invigorating blood circulation, down regulate inflammation and so on. Jiawei Yanghe decoction possess multiple capabilities such as preventing chondrocyte apoptosis, preserving integrity of extracellular matrix and anti-inﬂammatory in OA treatment both in vitro and in vivo(16). Tougu Xiaotong capsules can relief OA through p38 MAPK pathway-related mechanisms(20). Guzhi Zengsheng Zhitongwan could significantly promote chondrocyte viability and prevented their further differentiation(28). There is quite a number of TCM, while all the studies above are small scale or just studies in vitro for single TCM. There were rare large scale studies about TCM treatment on OA. The present study investigate the efﬁcacy of TCM in OA patients using a nationwide database. Results shows that TCM can reduce the hospitalization rate. Pei-Chia Lo et al got the similar results as ours that TCM can reduced risk of total knee replacement in knee OA patients(29). But meanwhile our result showed that usage of TCM in OA patients may increase the medical expenses. This may because of patients who take TCM have to come back to outpatient to adjust the treatment plan and TCM dosage.

A major strength of our study is that NHIRD is a peer-reviewed long-term population-based database which covered about 99% of 23 million Taiwan inhabitants. However, there are several limitations in this study. Firstly, the NHIRD did not include the tests related to the patients` joint activity, pain scales, and X-rays results. Besides these, many other factors may influence the prognosis of OA. To minimize these bias, we did propensity score matching on important covariates, co-morbidities and co-medications including age, sex, income, urbanization, hypertension, hyperlipidemia, Charlson comorbidity index and NSAIDs usage. Second, this study contained only 20 kinds of commonly prescribed traditional Chinese medicine formula, while other treatments for example tai chi, qi-gong, acupuncture, moxibustion et al are not included in the health care system. These items will be included in the study design of our future works.

In conclusion, this present nationwide population-based cohort study showed that TCM use was associated with a reduced of hospitalization of OA patients. We suggest that TCM may play a complementary role in OA treatment.

OA	Osteoarthritis
TCM	Traditional Chinese medicine
NHIRD	National Health Institutes Research Database

Consent for publication

Not applicable.

Availability of data and material

The data will be accessible by contacting the corresponding author of this study.

Competing interests

No conflicts of interest were declared.

Funding

None.

Authors` contributions

Yanping Zhao, Shuya Wang, James Cheng-Chung and Zhiyi Zhang wrote the manuscript. Yu-Hsun Wang analysed the data. All authors: data collection at the respective centres, read and approved the final manuscript.

Acknowledgements

We sincerely thank the support of Chun Shan Medical University, grant number CS19101.

Ethics approval and consent to participate

This study is approved by Ethics committee of Chun Shan Medical University (CSMUH No. CS17114).

Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nature reviews Rheumatology. 2014;10(7):437-41. Epub 2014/03/26.
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-59. Epub 2019/04/30.
Kotti M, Duffell LD, Faisal AA, McGregor AH. The complexity of human walking: a knee osteoarthritis study. PloS one. 2014;9(9):e107325. Epub 2014/09/19.
Brandt KD, Radin EL, Dieppe PA, van de Putte L. Yet more evidence that osteoarthritis is not a cartilage disease. Annals of the rheumatic diseases. 2006;65(10):1261-4. Epub 2006/09/16.
Martel-Pelletier J, Barr AJ, Cicuttini FM, Conaghan PG, Cooper C, Goldring MB, et al. Osteoarthritis. Nature reviews Disease primers. 2016;2:16072. Epub 2016/10/14.
Fu K, Robbins SR, McDougall JJ. Osteoarthritis: the genesis of pain. Rheumatology (Oxford). 2018;57(suppl_4):iv43-iv50. Epub 2017/12/22.
Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Seminars in arthritis and rheumatism. 2014;43(6):701-12. Epub 2014/01/07.
Li XH, Liang WN, Liu XX. Clinical observation on curative effect of dissolving phlegm-stasis on 50 cases of knee osteoarthritis. Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan. 2010;30(2):108-12. Epub 2010/07/27.
Lee HJ, Park HJ, Chae Y, Kim SY, Kim SN, Kim ST, et al. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clinical rehabilitation. 2009;23(6):504-11. Epub 2009/04/25.
Brismee JM, Paige RL, Chyu MC, Boatright JD, Hagar JM, McCaleb JA, et al. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clinical rehabilitation. 2007;21(2):99-111. Epub 2007/02/01.
Williamson L, Wyatt MR, Yein K, Melton JT. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology (Oxford). 2007;46(9):1445-9. Epub 2007/07/03.
Essex MN, O'Connell MA, Behar R, Bao W. Efficacy and safety of nonsteroidal anti-inflammatory drugs in Asian patients with knee osteoarthritis: summary of a randomized, placebo-controlled study. International journal of rheumatic diseases. 2016;19(3):262-70. Epub 2015/05/21.
McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and cartilage. 2014;22(3):363-88. Epub 2014/01/28.
Hou PW, Fu PK, Hsu HC, Hsieh CL. Traditional Chinese medicine in patients with osteoarthritis of the knee. Journal of traditional and complementary medicine. 2015;5(4):182-96. Epub 2015/11/21.
Yang M, Jiang L, Wang Q, Chen H, Xu G. Traditional Chinese medicine for knee osteoarthritis: An overview of systematic review. PloS one. 2017;12(12):e0189884. Epub 2017/12/22.
Xia H, Cao D, Yang F, Yang W, Li W, Liu P, et al. Jiawei Yanghe decoction ameliorates cartilage degradation in vitro and vivo via Wnt/beta-catenin signaling pathway. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie. 2020;122:109708. Epub 2020/01/10.
Wang L, Zhang Y, Wang Z, Gong N, Kweon TD, Vo B, et al. The Antinociceptive Properties of the Corydalis yanhusuo Extract. PloS one. 2016;11(9):e0162875. Epub 2016/09/14.
Luo Y, Wang CZ, Sawadogo R, Tan T, Yuan CS. Effects of Herbal Medicines on Pain Management. The American journal of Chinese medicine. 2020;48(1):1-16. Epub 2020/02/15.
Chen Z, Zhang C, Gao F, Fu Q, Fu C, He Y, et al. A systematic review on the rhizome of Ligusticum chuanxiong Hort. (Chuanxiong). Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association. 2018;119:309-25. Epub 2018/02/28.
Li X, Zhang Z, Liang W, Zeng J, Shao X, Xu L, et al. Tougu Xiaotong capsules may inhibit p38 MAPK pathway-mediated inflammation: In vivo and in vitro verification. Journal of ethnopharmacology. 2020;249:112390. Epub 2019/11/25.
Xiong W, He FF, You RY, Xiong J, Wang YM, Zhang C, et al. Acupuncture Application in Chronic Kidney Disease and its Potential Mechanisms. The American journal of Chinese medicine. 2018;46(6):1169-85. Epub 2018/10/06.
Huang Y, Zhu J, Lin X, Hong Y, Feng Y, Shen L. Potential of Fatty Oils from Traditional Chinese Medicine in Cancer Therapy: A Review for Phytochemical, Pharmacological and Clinical Studies. The American journal of Chinese medicine. 2019;47(4):727-50. Epub 2019/05/17.
Luo Y, Wang CZ, Hesse-Fong J, Lin JG, Yuan CS. Application of Chinese Medicine in Acute and Critical Medical Conditions. The American journal of Chinese medicine. 2019;47(6):1223-35. Epub 2019/09/12.
Wang S, Long S, Wu W. Application of Traditional Chinese Medicines as Personalized Therapy in Human Cancers. The American journal of Chinese medicine. 2018;46(5):953-70. Epub 2018/07/11.
Li L, Yao H, Wang J, Li Y, Wang Q. The Role of Chinese Medicine in Health Maintenance and Disease Prevention: Application of Constitution Theory. The American journal of Chinese medicine. 2019;47(3):495-506. Epub 2019/04/27.
Xu ZH, Gao YY, Zhang HT, Ruan KF, Feng Y. Progress in Experimental and Clinical Research of the Diabetic Retinopathy Treatment Using Traditional Chinese Medicine. The American journal of Chinese medicine. 2018:1-27. Epub 2018/10/05.
Chen H, Yang M, Ning Z, Lam WL, Zhao YK, Yeung WF, et al. A Guideline for Randomized Controlled Trials of Acupuncture. The American journal of Chinese medicine. 2019;47(1):1-18. Epub 2019/01/08.
Yao B, Lu B, Gao H, Zhang M, Leng X, Zhao D. Guzhi Zengsheng Zhitongwan, a Traditional Chinese Medicinal Formulation, Stimulates Chondrocyte Proliferation through Control of Multiple Genes Involved in Chondrocyte Proliferation and Differentiation. Evidence-based complementary and alternative medicine : eCAM. 2018;2018:7265939. Epub 2018/10/03.
Lo PC, Lin FC, Tsai YC, Lin SK. Traditional Chinese medicine therapy reduces the risk of total knee replacement in patients with knee osteoarthritis. Medicine. 2019;98(23):e15964. Epub 2019/06/07.

Table 1. Demographic characteristics of TCM and Non-TCM
	TCM (N = 6737)		Non-TCM (N =6737)
	n	%	n	%	p-value
Age, yr					0.830
20-40	698	10.4	617	9.2
40-65	4114	61.1	4177	62.0
≧65	1925	28.6	1943	28.8
Mean ± SD	56.6 ± 13.4		58.3 ± 14.1		<0.001**
Gender					0.830
Female	4277	63.5	4289	63.7
Male	2460	36.5	2448	36.3
Monthly income					0.461
<NT$20000	3235	48.0	3273	48.6
NT $20,000-NT $40,000	2379	35.3	2394	35.5
≧NT $40,000	1123	16.7	1070	15.9
Urbanization					0.661
Urban	4129	61.3	4176	62.0
Suburban	1999	29.7	1974	29.3
Rural	609	9.0	587	8.7
Hypertension	1841	27.3	1814	26.9	0.601
Hyperlipidemia	867	12.9	838	12.4	0.452
Charlson comorbidity index					0.481
0	3592	53.3	3600	53.4
1	2524	37.5	2555	37.9
≥2	621	9.2	582	8.6
NSAIDs	1447	21.5	1443	21.4	0.933
Medical expenses
Median (IQR)	23208 (11942-44114)		14294 (5250-34812)		<0.001**
Ln (Medical expenses)
Mean ± SD	10.0 ± 1.4		9.2 ± 2.5		<0.001**
p<0.05, *p<0.01

Table 2. Logistic regression analysis of emergency visit rate
	N	No. of emergency	Crude OR		95% C.I.	Adjusted OR^†		95% C.I.
TCM
No	6737	1288	1			1
Yes	6737	1353	1.06		0.98-1.16	1.06		0.97-1.15
Age
40-65	8291	1443	1			1
20-40	1315	276	1.26	**	1.09-1.46	1.44	**	1.24-1.67
≧65	3868	922	1.49	**	1.35-1.63	1.12	*	1.01-1.25
Gender
Female	8566	1597	1			1
Male	4908	1044	1.18		1.08-1.29	1.06		0.97-1.16
Monthly income
<NT$20000	6508	1430	1			1
NT $20,000-NT $40,000	4773	878	0.80	**	0.73-0.88	0.86	**	0.78-0.95
≧NT $40,000	2193	333	0.64	**	0.56-0.72	0.75	**	0.66-0.87
Urbanization
Urban	8305	1575	1			1
Suburban	3973	797	1.07		0.98-1.18	1.04		0.95-1.15
Rural	1196	269	1.24	**	1.07-1.44	1.18	*	1.01-1.37
Hypertension	3655	897	1.51	**	1.37-1.65	1.23	**	1.11-1.36
Hyperlipidemia	1705	375	1.18	**	1.05-1.34	0.98		0.86-1.11
Charlson comorbidity index
0	7192	1076	1			1
1	5079	1209	1.78	**	1.62-1.95	1.65	**	1.5-1.82
≥2	1203	356	2.39	**	2.08-2.75	2.12	**	1.83-2.45
NSAIDs	2890	700	1.42	**	1.29-1.57	1.20	**	1.08-1.33
†Adjusted for age, gender, monthly income, urbanization, hypertension, hyperlipidemia, Charlson comorbidity index and NSAIDs. p<0.05, *p<0.01

Table 3. Logistic regression analysis of hospitalization rate
	N	No. of admission	Crude OR		95% C.I.	Adjusted OR^†		95% C.I.
TCM
No	6737	978	1			1
Yes	6737	867	0.87	**	0.79-0.96	0.86	**	0.78-0.95
Age
40-65	8291	910	1			1
20-40	1315	130	0.89		0.73-1.08	1.07		0.88-1.31
≧65	3868	805	2.13	**	1.92-2.36	1.39	**	1.24-1.56
Gender
Female	8566	1044	1			1
Male	4908	801	1.41	**	1.27-1.55	1.18	**	1.07-1.32
Monthly income
<NT$20000	6508	1079	1			1
NT $20,000-NT $40,000	4773	591	0.71	**	0.64-0.79	0.80	**	0.72-0.9
≧NT $40,000	2193	175	0.44	**	0.37-0.52	0.63	**	0.53-0.76
Urbanization
Urban	8305	1025	1			1
Suburban	3973	623	1.32	**	1.19-1.47	1.25	**	1.12-1.4
Rural	1196	197	1.40	**	1.19-1.65	1.24	*	1.04-1.49
Hypertension	3655	725	1.92	**	1.73-2.13	1.28	**	1.14-1.43
Hyperlipidemia	1705	254	1.12		0.97-1.29	0.82	*	0.71-0.96
Charlson comorbidity index
0	7192	628	1			1
1	5079	852	2.11	**	1.89-2.35	1.78	**	1.59-2.00
≥2	1203	365	4.55	**	3.93-5.28	3.53	**	3.02-4.13
NSAIDs	2890	609	2.02	**	1.81-2.25	1.55	**	1.38-1.73
†Adjusted for age, gender, monthly income, urbanization, hypertension, hyperlipidemia, Charlson comorbidity index and NSAIDs. p<0.05, *p<0.01

Table 4. Linear regression analysis of medical expenses
	Crude Beta		SE	Adjusted Beta^†		SE
TCM
No	1			1
Yes	0.78	**	0.03	0.78	**	0.03
Age
40-65	1			1
20-40	-0.49	**	0.06	-0.23	**	0.06
≧65	0.46	**	0.04	0.11	**	0.04
Gender
Female	1			1
Male	-0.01		0.04	-0.15	**	0.04
Monthly income
<NT$20000	1			1
NT $20,000-NT $40,000	-0.14	**	0.04	0.03		0.04
≧NT $40,000	-0.30	**	0.05	0.01		0.05
Urbanization
Urban	1			1
Suburban	-0.03		0.04	-0.08	*	0.04
Rural	0.15	*	0.06	0.02		0.06
Hypertension	0.93	**	0.04	0.53	**	0.04
Hyperlipidemia	0.82	**	0.05	0.41	**	0.05
Charlson comorbidity index
0	1			1
1	0.87	**	0.04	0.65	**	0.04
≥2	1.20	**	0.06	0.87	**	0.06
NSAIDs	0.81	**	0.04	0.53	**	0.04
†Adjusted for age, gender, monthly income, urbanization, hypertension, hyperlipidemia, Charlson comorbidity index and NSAIDs. p<0.05, *p<0.01

No competing interests reported.

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Traditional Chinese Medicine Reduces Hospitalization Risk of Osteoarthritis Patients: A 13- Year Population-based Cohort Study

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