AlOtaibi, Nouf
(2025)
Epidemiology of chronic shoulder pain in the United Kingdom.
PhD thesis, University of Nottingham.
Abstract
Background
Chronic shoulder pain (CSP) is a common musculoskeletal condition that can significantly affect a person’s ability to work, sleep, and perform daily activities. It affects between 5% and 47% of the adult population annually worldwide. In the United Kingdom (UK), about 2.4% of adult people aged between 18 and 60 years old consulted their general practitioners (GPs) for CSP in 2006. However, whether the occurrence of CSP has changed in the past 20 years in the UK, whether it varies between geographical regions, and its associated comorbidities and consequences remain largely unknown.
Objectives
This research aimed to answer five objectives
[1] to systematically review the existing literature on the prevalence and incidence of CSP and its related risk factors, and associated comorbidities.
[2] to determine the current prevalence and incidence of CSP in the UK (2019).
[3] to determine the trends of prevalence and incidence of CSP in the UK over the past twenty years (2000 - 2020).
[4] to examine potential risk factors, and comorbidities that precede the diagnosis of CSP.
[5] to explore the outcomes of CSP including associated comorbidities, all-cause mortality, consultations and hospitalisations.
Methods
[1] a systematic review and meta-analysis were performed to summarise the literature on the prevalence and incidence of CSP and the associated risk factors in people aged 40 years and over.
The nationally representative UK primary care database, the Clinical Practice Research Datalink (CPRD) Aurum was used to determine:
[2&3] the cross-sectional prevalence, incidence, and trend of CSP in the UK
[4] risk factors and comorbidities occurring before the diagnosis of CSP using a case-control study design
[5] outcomes occurring after CSP diagnosis using a cohort study design.
Results
A total of 29 studies from 19 countries were identified in the systematic review. Of which, 20 had a high quality, and nine had moderate quality. The pooled prevalence of CSP in the included studies was 29% and higher in specific populations such as people with physically demanding occupations (36% prevalence), and people with diabetes (35% prevalence). The incidence of CSP was higher in females and in those aged over 40 years. In addition to age and sex, CSP was associated with smoking, lower educational level, manual labour, have been reported to associate with CSP. Also, CSP was found to be associated with a number of comorbidities, including arthritis, diabetes, angina, and other sites of musculoskeletal (MSK) pain.
In the UK, the prevalence of CSP in people aged 18 and above in 2019 was found to be 1.9 % and the incidence was 1.2 per 1000 person-years. The prevalence and incidence were more common in females than males and increased with age, especially after age 40 years. The prevalence was found to increase during the study period from 0.42% in 2000 to 1.83 in 2020, whereas the incidence increased significantly from 0.88 in 2000 to 2.00 per 1000-person year in 2011, then decreased afterwards. The significant decline of the incidence in 2020 resulted from the reduced consultations during the COVID-19 pandemic and lockdown. Smoking, low socioeconomic status, Asian and mixed ethnicity, and a high body mass index increased the risk of CSP, while current alcohol consumers had a significantly lower risk of having CSP.
People with CSP were more likely to have comorbidities prior to and post the diagnosis of CSP compared to the control group. Retrospectively, people with other MSK conditions (aOR 1.71, 95% CI 1.68 to1.75), osteoarthritis (OA) (aOR 1.76, 95% CI 1.70 to1.82), diabetes (aOR 1.48, 95% CI 1.43 to1.53), fibromyalgia (aOR 1.40, 95% CI 1.32 to 1.48), and insomnia (aOR 1.63, 95% CI 1.58 to1.69) were more likely to have CSP.
Prospectively, people with CSP were more likely to develop other long-term conditions compared to the control group. Of the twenty-two comorbidities studied, significant associations were seen with eighteen conditions. The strongest associations found were with sarcopenia (HR 1.74, 95% CI 1.11 to 2.71), fibromyalgia (HR 1.71, 95% CI 1.62,1.81), osteoarthritis (HR 1.60, 95% CI 1.55 to 1.64), other MSK conditions (HR 1.61, 95% CI 1.58 to1.64), and insomnia (HR 1.55, 95% CI 1.48 to1.63). Following their diagnosis, people with CSP had three times higher risk of GP consultations, 44% higher risk of hospitalisations, and 6% higher risk of all-cause mortality than those without CSP.
Conclusion
Chronic shoulder pain (CSP) affects around 2% of adults in the UK. The prevalence of this condition in primary care increased gradually in the past 20 years whereas the incidence has increased until 2011 then decreased afterwards (reasons to be investigated). The findings demonstrated that age, sex, smoking, socioeconomic deprivation, Asian or mixed ethnicity and higher BMI were associated with an increased risk of CSP. Alcohol consumption was associated with a decreased risk of CSP. People with CSP had a higher burden of comorbidities, higher risk of mortality, and increased healthcare utilisations. This study has provided essential background information/evidence of CSP in the UK for policymakers to allocate resources, healthcare providers to optimally manage CSP, and researchers to undertake further research such as the causality between shoulder pain and individual comorbidities.
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