title: Impact of clinical osteoarthritis of the hip, knee and hand on self-rated health in six European countries: the European Project on OSteoArthritis.
abstract: Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH.
  
  
  
  Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index.
  
  
  
  The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function.
  
  
  
  Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. nm.vanschoor@vumc.nl.
authors.forename: N M
authors.initials: NM
authors.lastname: van Schoor
authors.affiliation: Department of Medical and Surgical Sciences, University of Padova, Padua, Italy.|National Research Council, Aging Branch, Institute of Neuroscience, Padua, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Zambon
authors.affiliation: Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: M V
authors.initials: MV
authors.lastname: Castell
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Bethesda Geriatric Clinic, University of Ulm, Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Denkinger
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Dennison
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Edwards
authors.affiliation: Institute of the History, Philosophy and Ethics of Medicine, University of Ulm, Ulm, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Herbolsheimer
authors.affiliation: National Research Council, Aging Branch, Institute of Neuroscience, Padua, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Maggi
authors.affiliation: Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Martinez
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: N L
authors.initials: NL
authors.lastname: Pedersen
authors.affiliation: Institute of the History, Philosophy and Ethics of Medicine, University of Ulm, Ulm, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Peter
authors.affiliation: Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: L A
authors.initials: LA
authors.lastname: Schaap
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: J J M
authors.initials: JJ
authors.lastname: Rijnhart
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van der Pas
authors.affiliation: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: D J H
authors.initials: DJ
authors.lastname: Deeg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005858:Germany; D006225:Hand / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D007558:Italy; D008297:Male; D009426:Netherlands; D010003:Osteoarthritis / Q000503:physiopathology*; D015207:Osteoarthritis, Hip / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000503:physiopathology; D015995:Prevalence; D011788:Quality of Life; D057566:Self Report; D018434:Sickness Impact Profile; D013030:Spain; D013548:Sweden; D006113:United Kingdom
keywords: Europe; General population; Osteoarthritis; Self-rated health