Abstract
BACKGROUND AND AIM: Osteoarthritis (OA) is a leading cause of chronic disability worldwide, and its burden is increasing sharply in low- and middle-income countries (LMICs) such as Pakistan. This study aimed to assess the temporal trends, site-specific burden, sex-based disparities, and provincial variations in the prevalence, incidence, years lived with disability (YLDs), and disability-adjusted life years (DALYs) due to OA in Pakistan from 1990 to 2021, using data from the Global Burden of Disease (GBD) 2021 study. METHODS: Data were extracted from the GBD 2021 database, encompassing national and subnational estimates. Age-standardized rates of OA prevalence, incidence, DALYs, and YLDs were analyzed for Pakistan and its provinces. Site-specific data for knee, hand, hip, and other forms of OA were also evaluated. Sex-stratified analyses were conducted. Temporal patterns were assessed using Joinpoint regression, with annual percent change (APC) and 95% confidence intervals (CIs) calculated for each segment. RESULTS: Between 1990 and 2021, the prevalence of OA in Pakistan rose from 2.85 million to 8.49 million. The age-standardized prevalence increased from 4,966 (95% UI: 4,389-5,580) to 5,854 (95% UI: 5,137-6,550) per 100,000 population, a 17.9% rise. Women experienced a higher burden, reaching 7,179 per 100,000 in 2021 versus 4,645 in men. Islamabad Capital Territory (ICT) recorded the highest prevalence (7,160 per 100,000), while Khyber Pakhtunkhwa (KPK) had the lowest (5,606 per 100,000). The age-standardized incidence rate rose from 394.1 (95% UI: 346.6-441.4) to 458.0 (95% UI: 402.5-509.9) per 100,000, with knee OA contributing over 61% of new cases. The DALY rate rose by 19.1%, from 168.5 to 200.6 per 100,000. Women had higher DALYs (248.2) than men (157.2). The highest provincial DALYs were observed in Islamabad (250.7) and the lowest in Khyber Pakhtunkhwa (191.3) in 2021. CONCLUSION: The OA burden in Pakistan has grown significantly over the past three decades, especially among women and in urbanized provinces. Public health policies should focus on early diagnosis, fair access to rehabilitation, and promoting healthy lifestyles to reduce the growing burden of osteoarthritis.