What question did this study set out to answer?

This study aims to clarify the relationship between digestive diseases and the risk of developing knee osteoarthritis in older Chinese adults.

May 10, 2026BMC Public Health0 citationsOpen Access

Association between digestive diseases and symptomatic knee osteoarthritis in Chinese participants: a prospective cohort study

SCS ChenJiangxi University of Traditional Chinese Medicine YLYoudi LiuJiangxi University of Traditional Chinese Medicine DZDaocheng ZhuJiangxi University of Traditional Chinese Medicine

Key Points

This study aims to clarify the relationship between digestive diseases and the risk of developing knee osteoarthritis in older Chinese adults.
Data sourced from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018.
6,281 middle-aged and older adults without knee OA at baseline were followed for a median of 84 months.
Kaplan-Meier survival curves, Cox proportional hazards models, and sensitivity analyses including propensity score matching were employed.
Participants with digestive diseases had a cumulative incidence of symptomatic knee OA of 31.4% compared to 20.9% for those without (log-rank p < 0.01).
Cox models adjusted for confounders indicated a higher risk of knee OA (adjusted HR = 1.40; 95% CI: 1.25–1.57; p < 0.001).
Similar HR results were found in the PSM analysis (HR = 1.42; 95% CI: 1.23–1.64; p < 0.001).

Abstract

Digestive diseases and symptomatic knee osteoarthritis (OA) frequently occur in older adults, yet prospective evidence clarifying their temporal relationship remains limited, particularly in Asian populations. This study examined the relationship between digestive diseases and the risk of incident symptomatic knee OA in a nationally representative cohort of middle‑aged and older Chinese adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. A total of 6,281 adults without symptomatic knee OA at baseline were included. Digestive diseases were defined as exposure, and incident symptomatic knee osteoarthritis was the outcome of interest. Kaplan-Meier survival curves with log‑rank tests were used to compare cumulative incidence, and multivariable Cox proportional hazards models were applied to estimate hazard ratios. Sensitivity analyses included propensity score matching (PSM), prespecified subgroup analyses presented as forest plots, and E-value calculations. A total of 6,281 participants were included in the analytical cohort (mean age, 58.6 ± 8.8 years; 53.5% women), with a median follow‑up of 84 months. Over the observation period, participants reporting digestive diseases experienced a markedly higher cumulative incidence of symptomatic knee OA compared with those without digestive conditions (31.4% versus 20.9%; log‑rank p < 0.01). After adjustment for potential confounders, multivariable Cox models indicated a higher risk of symptomatic knee OA among participants with digestive diseases (adjusted HR = 1.40; 95% CI: 1.25–1.57; p < 0.001). Similar effect estimates were obtained in the PSM (HR = 1.42; 95% CI: 1.23–1.64; p < 0.001). Subgroup analyses showed similar associations, with no statistically significant interactions detected. E‑value was 2.17. Digestive diseases are linked to a higher likelihood of symptomatic knee OA in this prospective cohort, supporting a temporal relationship between digestive disorders and the development of symptomatic knee OA.

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