Hand Osteoarthritis Burden Rises in Older Adults Through 2050
Key Takeaways
- Adults aged 55 years and older worldwide accounted for 80% of prevalent hand osteoarthritis cases and 79% of related years lived with disability in 2021.
- From 1990 to 2021, hand osteoarthritis burden in this age group rose across incidence, prevalence, and years lived with disability, with age-standardized rates also trending upward.
- In 2021, age-standardized incidence, prevalence, and years lived with disability rates in older adults were 2.89, 4.71, and 4.66 times those of the general population.
- Burden is projected to keep climbing through 2050, and hand osteoarthritis showed the steepest historical and projected growth among osteoarthritis subtypes.
A Lin et al. Medicine 2026 GBD 2021 analysis of global hand osteoarthritis burden in adults aged ≥55 years used Global Burden of Disease (GBD) 2021 data to examine incidence, prevalence, and years lived with disability (YLDs) in adults aged 55 years and older across 204 countries and territories at global, regional, and national levels. Hand osteoarthritis was defined as symptomatic radiographic osteoarthritis with Kellgren-Lawrence grade 2 to 4 in any hand joint, mapped to International Classification of Diseases, Tenth Revision (ICD-10) code M18 in coded sources. The analysis also assessed patterns by sex, age group, and sociodemographic index (SDI), evaluated 1990-2021 trends with estimated annual percentage change (EAPC) and percentage change, used Das Gupta decomposition to examine drivers of change, and forecast 2022-2050 burden with autoregressive integrated moving average (ARIMA) models.
From 1990 to 2021, adults aged 55 years and older experienced increases of +3.13 million incident cases, +95.32 million prevalent cases, and +2.99 million YLDs. Age-standardized incidence, prevalence, and disability rates also increased over the same period, suggesting that the rise was not explained by demographic change alone.
In 2021, the global burden in this age group reached 5.13 million incident cases, 154.68 million prevalent cases, and 4.86 million YLDs. Older adults accounted for nearly half of incident cases and about four-fifths of prevalent cases and disability burden worldwide. Six countries accounted for more than half of the absolute burden, and the United States was among those highest-burden countries.
Looking ahead, the authors projected 8.99 million incident cases, 291.92 million prevalent cases, and 8.96 million YLDs in 2050 among adults aged 55 years and older, although the source notes that 95% prediction intervals for 2050 outcomes were sometimes wide. The middle SDI region showed the largest increases, the high SDI region had the highest age-standardized rates, burden rose more sharply in females, and incidence rates peaked at ages 55 to 59. Population growth emerged as the main driver of global change, and hand osteoarthritis outpaced other osteoarthritis subtypes in both historical and projected growth even though knee osteoarthritis remained larger overall.
These are modeled GBD estimates assembled from countries and territories with differing diagnostic criteria, screening practices, and surveillance systems. Some regions had limited primary data, which can widen uncertainty around country-level rankings; the authors noted that estimates for places such as Kazakhstan should be interpreted cautiously. The analysis did not model specific risk factors such as obesity or occupational exposure, did not separate hand osteoarthritis subtypes, and projected forward under the assumption that past epidemiologic patterns continue rather than incorporating future changes in diagnosis, prevention, or treatment.
According to the authors, adults aged 55 years and older bear a disproportionate and still-rising share of global hand osteoarthritis burden. In this analysis, the growth trajectory in this age group also exceeded that of other osteoarthritis subtypes.
Clinician Questions
How was hand osteoarthritis defined in the global burden analysis of adults aged 55 years and older?
In adults aged 55 years and older, the analysis defined hand osteoarthritis as symptomatic radiographic osteoarthritis with Kellgren-Lawrence grade 2 to 4 in any hand joint, with ICD-10 code M18 used as the mapped code in coded data sources. This case definition underpinned the incidence, prevalence, and YLD estimates for the older population.
What factors drove the rise in global hand osteoarthritis burden among adults aged 55 years and older?
For adults aged 55 years and older, the decomposition analysis identified population growth as the main driver of rising hand osteoarthritis incidence, prevalence, and YLD burden globally and across SDI groups, followed by epidemiological change and population aging. This pattern suggests that expansion of the older population contributed more to the increase than any single modeled clinical exposure.
Which populations and regions showed the strongest hand osteoarthritis burden patterns in older adults?
Among adults aged 55 years and older, the middle SDI region showed the largest increases in burden, while the high SDI region had the highest age-standardized rates. Burden rose more sharply in females than in males, and age-standardized incidence peaked in the 55 to 59 age group.
How certain are the country rankings and 2050 forecasts for hand osteoarthritis in older adults?
Country rankings and 2050 forecasts for hand osteoarthritis in adults aged 55 years and older come from a modeled global database built from heterogeneous national data sources, so precision varied across regions. The authors noted that limited data reduced certainty for some country-level estimates and identified Kazakhstan as an example requiring caution, while the ARIMA forecasts assume continuation of past epidemiologic patterns rather than future changes in diagnosis, prevention, or treatment.