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J Investig Med. 2011 Aug;59(6):956-60. doi: 10.2310/JIM.0b013e318224d8b8.

Health coverage and its relation to the prevalence and intensity of symptomatic knee osteoarthritis.

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University of Iowa, Iowa City, IA, USA.



This study aimed to determine whether health coverage among older adults is associated with (1) the prevalence of symptomatic knee osteoarthritis (OA) and (2) disablement in those with symptomatic knee OA.


Data were collected from the Osteoarthritis Initiative data set 5.2.1, a cohort study of subjects with or at risk for knee OA. Prevalence of symptomatic knee OA (knee symptoms on most of the last 30 days and Kellgren-Lawrence grade >2 on knee radiograph) was compared between those with and without health coverage among subjects aged 45 to 65 years, adjusted for age and body mass index. For those with symptomatic knee OA, Physical Activity for the Elderly scores and Knee Osteoarthritis Outcomes Survey function, pain, and quality-of-life scores were compared between those with and without health coverage before and after adjustment for age and body mass index.


Among subjects with health coverage, 27.8% had symptomatic knee OA compared with 36.1% of those without health coverage (P = 0.0204 before and P > 0.24 after adjustment). Among subjects with symptomatic knee OA with and without health coverage physical activity differed significantly (P = 0.048), as did pain (P < 0.0001), function (P = 0.0001), and quality of life (P < 0.0001).


Lack of health coverage was not associated with the prevalence of symptomatic knee OA after adjustment. However, those with symptomatic knee OA without health coverage reported reduced physical activity, greater pain, worse functional limitations, and decreased quality of life.

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