Article Text
Abstract
Objective This cohort study evaluates the unknown age-specific and gender-specific incidence of primary shoulder dislocations in the UK.
Setting UK primary care data from the Clinical Practice Research Datalink (CPRD) were used to identify patients aged 16–70 years with a shoulder dislocation during 1995–2015. Coding of primary shoulder dislocations was validated using the CPRD general practitioner questionnaire service.
Participants A cohort of 16 763 patients with shoulder dislocation aged 16–70 years during 1995–2015 were identified.
Primary outcome measure Incidence rates per 100 000 person-years and 95% CIs were calculated.
Results Correct coding of shoulder dislocation within CPRD was 89% (95% CI 83% to 95%), and confirmation that the dislocation was a ‘primary’ was 76% (95% CI 67% to 85%). Seventy-two percent of shoulder dislocations occurred in men. The overall incidence rate in men was 40.4 per 100 000 person-years (95% CI 40.4 to 40.4), and in women was 15.5 per 100 000 person-years (95% CI 15.5 to 15.5). The highest incidence was observed in men aged 16–20 years (80.5 per 100 000 person-years; 95% CI 80.5 to 80.6). Incidence in women increased with age to a peak of 28.6 per 100 000 person-years among those aged 61–70 years.
Conclusions This is the first time the incidence of shoulder dislocations has been studied using primary care data from a national database, and the first time the results for the UK have been produced. While most primary dislocations occurred in young men, an unexpected finding was that the incidence increased in women aged over 50 years, but not in men. The reasons for this are unknown. Further work is commissioned by the National Institute for Health Research to examine treatments and predictors for recurrent shoulder dislocation.
Study registration The design of this study was approved by the Independent Scientific Advisory Committee (15_260) for the Medicines & Healthcare products Regulatory Agency.
- shoulder dislocation
- incidence
- clinical practice research datalink
- cprd
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Footnotes
Contributors AS analysed the data and drafted the paper. AJ assisted with the analysis and commented on the paper. AD assisted with managing and cleaning the data and commented on the paper. KE assisted with the literature review, data access and internal validation of the study and commented on the paper. NKA, DP-A, AJC, TAH, RAP-V, SH, SEL, AR and GC commented on the paper. JR designed the study, oversaw the analysis and revised the paper.
Funding This project was funded by the National Institute of Health and Research (NIHR) Health Technology Assessment (HTA) Programme (project number: 14/160). The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).
Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NHS, the NIHR or the Department of Health. All researchers are independent from the study funders. This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The funding source had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript.
Competing interests AJ has received a grant from NIHR HS & DR during the conduct of the study, and has received consultancy, lecture fees and honoraria from Servier, UK Renal Registry, Oxford Craniofacial Unit, IDIAP Jordi Gol, Freshfields Bruckhaus Deringer, has held advisory board positions (which involved receipt of fees) from Anthera Pharmaceuticals, Inc., and received research sponsorship from ROCHE. NKA has received honoraria, held advisory board positions (which involved receipt of fees) and received consortium research grants from Merck (honorarium); Roche, Novartis and Bioiberica (grants); Smith & Nephew, Nicox, Flexion Bioventus and Freshfields (personal fees) outside the submitted work. DP-A has received research grants from Amgen and Laboratoires Servier. TH is a GP in London, and is a GP advisor for, but not employed by, the Clinical Practice Research Datalink (CPRD). AR has received personal fees from DePuy Ltd., Aviva Health, AXA PPP Healthcare, AXA PPP International, BUPA, Cigna, SecureHealth, Simplyhealth, Vitality Health (Pru Health) and WPA; a grant from JRI Ltd.; and has a patent for a shoulder replacement prosthesis.
Ethics approval The Independent Scientific Advisory Committee (ISAC)
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are not available for sharing.