Osteoarthritis across Joint Sites in the Million Veteran Program: Insights from Electronic Health Records and Military Service History

Objective. To characterize the relationship between OA frequency and a host of demographic characteristics, comorbidities, military service history, and physical health variables in a veteran population. Methods. We investigated the Million Veteran Program (MVP) cohort to outline frequency of OA across six joint sites (knee, spine, hip, hand, finger, thumb) in veterans with respect to demographics (age, sex, race/ethnicity, etc.), military service data, and detailed electronic health records profiling OA and other comorbidities. The large veteran contingent provided the unique opportunity to investigate the association of OA with prior service across military branches and war eras. Results. We validated previous reports of sex- and age-dependent differences in OA frequency, and we identified that generalized OA was associated with a higher frequency of sixteen Deyo-Charlson comorbidities. These associations generally persisted within each isolated joint site-specific OA. Depending on military branch, prior military engagement was differentially associated with frequency of OA. Prior Army and Navy service were associated with higher and lower risk, respectively of OA across all joint sites. However, multivariable-adjusted models adjusting for a range of covariates (including age, sex, and ancestry) reversed the apparent protective effect of prior Navy service. Conclusion. These findings highlight the breadth of factors associated with OA in the MVP veteran population and suggest that physical status may be a modifiable risk factor for OA. This work may contribute to designing strategies to optimize appropriate detection, intervention, treatment, and even rehabilitation strategies for OA in veterans and the general population. ### Competing Interest Statement JAS has received consultant fees from AstraZeneca Schipher Crealta/Horizon Medisys Fidia PK Med Two labs Inc Adept Field Solutions Clinical Care options Clearview healthcare partners Putnam associates Focus forward Navigant consulting Spherix MedIQ Jupiter Life Science UBM LLC Trio Health Medscape WebMD Practice Point communications the National Institutes of Health the American College of Rheumatology JAS has received institutional research support from Zimmer Biomet Holdings JAS received food and beverage payments from Intuitive Surgical Inc /Philips Electronics North America JAS owns stock options in Atai life sciences Kintara therapeutics Intelligent Biosolutions Acumen pharmaceutical TPT Global Tech Vaxart pharmaceuticals Atyu biopharma Adaptimmune Therapeutics GeoVax Labs Pieris Pharmaceuticals Enzolytics Inc Seres Therapeutics Tonix Pharmaceuticals Holding Corp Charlottes Web Holdings Inc JAS previously owned stock options in Amarin Viking Moderna pharmaceuticals JAS is on the speakers bureau of Simply Speaking JAS was a member of the executive of Outcomes Measures in Rheumatology (OMERACT) which is an organization that develops outcome measures in rheumatology and receives arms-length funding from 8 companies JAS serves on the FDA Arthritis Advisory Committee JAS is the co-chair of the Veterans Affairs Rheumatology Field Advisory Board (FAB) JAS is the editor and the Director of the University of Alabama at Birmingham (UAB) Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis JAS previously served as a member of the following committees: membern in the American College of Rheumatology's (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees the Chair of the ACR Meet-the-Professor Workshop and Study Group Subcommittee and the co-chair of the ACR Criteria and Response Criteria subcommittee Other authors have no conflict of interest to disclose ### Funding Statement This research is based on data from the Million Veteran Program, Office of Research and Development, Veterans Health Administration, and was supported by award # I01RX002745. This publication does not represent the views of the Department of Veteran Affairs or the United States Government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Veterans Affairs Central Institutional Review Board and the University of Alabama at Birmingham (UAB) Institutional Review Board gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.