Osteoarthritis (OA) is the most common chronic degenerative joint disorder and a leading cause of pain, disability, and reduced quality of life worldwide. It is characterized by progressive degeneration of articular cartilage, subchondral bone remodeling, osteophyte formation, and varying degrees of synovial inflammation. OA most commonly affects weight-bearing joints such as the knee and hip, as well as the hands and spine, leading to significant functional impairment, especially in middle-aged and elderly populations. With increasing life expectancy, urbanization, and lifestyle transitions, the burden of osteoarthritis is rising steadily, making it an important public health concern.[1] Globally, osteoarthritis affects nearly 10–15% of adults over the age of 60 years, with higher prevalence observed in women, particularly after menopause. In India, OA is one of the leading causes of musculoskeletal morbidity, contributing substantially to years lived with disability. Rapid demographic aging, increasing obesity, sedentary lifestyle, and occupational stress have further amplified the prevalence of OA in both urban and rural settings. However, the pattern and determinants of osteoarthritis differ significantly between these populations due to variations in lifestyle, occupation, physical activity levels, access to healthcare, and socio-economic conditions. Urban populations are increasingly exposed to risk factors such as obesity, sedentary behavior, reduced physical activity, and metabolic disorders, all of which predispose individuals to osteoarthritis. In contrast, rural populations often engage in physically demanding occupations such as farming, manual labor, squatting, and heavy lifting, which impose repetitive mechanical stress on joints and may accelerate degenerative changes. Nutritional deficiencies, delayed healthcare access, and lack of awareness further influence disease progression in rural communities. These contrasting risk profiles highlight the need for comparative evaluation of osteoarthritis prevalence and associated risk factors across urban and rural populations.[2][3] Several studies have identified age, female gender, obesity, occupational strain, previous joint injury, genetic predisposition, and comorbidities such as diabetes and hypertension as key risk factors for OA. However, most available data are either hospital-based or region-specific, limiting their generalizability. There is a relative paucity of community-based comparative studies assessing osteoarthritis prevalence and risk factors across urban and rural populations within the same geographical region using standardized assessment criteria.[4] AIM To determine the prevalence and associated risk factors of osteoarthritis in urban and rural populations. OBJECTIVES 1. To estimate the prevalence of osteoarthritis among urban and rural populations. 2. To identify demographic, lifestyle, occupational, and clinical risk factors associated with osteoarthritis. 3. To compare the distribution of risk factors between urban and rural study participants.

Source of Data Data were collected from adult participants residing in selected urban and rural areas who consented to participate in the study. Study Design The study was a cross-sectional observational study. Study Location The study was conducted in selected urban and rural field practice areas attached to a tertiary care teaching hospital. Study Duration The study was carried out over a period of 12 months. Sample Size A total of 200 participants were included in the study, comprising equal representation from urban and rural populations. Inclusion Criteria • Adults aged ≥40 years • Residents of the selected urban or rural area for at least 5 years • Participants willing to provide informed consent Exclusion Criteria • History of inflammatory arthritis (e.g., rheumatoid arthritis, gout) • History of major joint trauma or surgery • Congenital joint disorders • Pregnant women • Participants unwilling to participate Procedure and Methodology Participants were selected using a systematic sampling method. After obtaining informed written consent, a pre-designed and pre-tested structured questionnaire was administered. The questionnaire included socio-demographic details, occupational history, lifestyle factors, comorbidities, and joint-related symptoms. Clinical assessment for osteoarthritis was performed based on standard diagnostic criteria. Anthropometric measurements such as height, weight, and body mass index (BMI) were recorded using standardized techniques. Sample Processing All collected data were checked for completeness and accuracy on the same day of collection. Data were coded and entered into a computerized database for analysis. Statistical Methods Data were analyzed using statistical software. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean and standard deviation. The chi-square test was used to assess associations between osteoarthritis and risk factors. A p-value <0.05 was considered statistically significant. Data Collection Data were collected through face-to-face interviews, clinical examination, and anthropometric measurements using standardized data collection tools.

Table 1: Prevalence and Associated Risk Factors of Osteoarthritis in Study Population (N = 200) Variable Category OA Present n (%) (n=82) OA Absent n (%) (n=118) Test of Significance 95% CI p-value Age (years) Mean ± SD 59.3 ± 8.6 51.1 ± 9.2 t = 6.21 5.4 to 10.9 <0.001 Sex Male 33 (40.2) 67 (56.8) χ² = 5.48 0.019 Female 49 (59.8) 51 (43.2) BMI (kg/m²) Mean ± SD 27.6 ± 3.9 24.3 ± 3.4 t = 6.01 2.1 to 4.4 <0.001 Occupational strain Yes 54 (65.9) 42 (35.6) χ² = 18.94 1.8 to 4.5 <0.001 Diabetes Mellitus Present 31 (37.8) 26 (22.0) χ² = 6.01 1.1 to 3.0 0.014 Table 1 summarizes the prevalence of osteoarthritis and its association with selected demographic and clinical risk factors among the study population of 200 participants. Osteoarthritis was present in 82 participants (41.0%) and absent in 118 participants (59.0%). The mean age of participants with osteoarthritis was significantly higher compared to those without osteoarthritis (59.3 ± 8.6 years vs. 51.1 ± 9.2 years), and this difference was statistically significant (t = 6.21, p <0.001), indicating increasing age as a strong risk factor. Female participants constituted a higher proportion of osteoarthritis cases (59.8%) compared to males (40.2%), with a statistically significant association between sex and osteoarthritis (χ² = 5.48, p = 0.019). The mean BMI was significantly higher among participants with osteoarthritis (27.6 ± 3.9 kg/m²) than those without osteoarthritis (24.3 ± 3.4 kg/m²), demonstrating a strong association between increased BMI and osteoarthritis (p <0.001). Occupational strain was markedly more common among participants with osteoarthritis (65.9%) compared to those without osteoarthritis (35.6%), showing a highly significant association (p <0.001). Additionally, diabetes mellitus was significantly more prevalent among osteoarthritis cases (37.8%) than controls (22.0%). Table 2: Prevalence of Osteoarthritis Among Urban and Rural Populations (N = 200) Residence OA Present n (%) OA Absent n (%) Total Test of Significance 95% CI p-value Urban (n=102) 34 (33.3) 68 (66.7) 102 χ² = 9.37 1.3 to 2.8 0.002 Rural (n=98) 48 (49.0) 50 (51.0) 98 Total 82 (41.0) 118 (59.0) 200 Table 2 depicts the distribution and prevalence of osteoarthritis among urban and rural populations. Of the 102 urban participants, 34 individuals (33.3%) were found to have osteoarthritis, whereas among the 98 rural participants, 48 individuals (49.0%) had osteoarthritis. The prevalence of osteoarthritis was significantly higher in the rural population compared to the urban population. This difference was statistically significant (χ² = 9.37, p = 0.002), with the confidence interval indicating higher odds of osteoarthritis among rural residents. Overall, the total prevalence of osteoarthritis in the study population was 41.0%. Table 3: Demographic, Lifestyle, Occupational and Clinical Risk Factors Associated with Osteoarthritis (N = 200) Risk Factor Category OA Present n (%) OA Absent n (%) Test Statistic 95% CI p-value Age Group ≥60 years 49 (59.8) 32 (27.1) χ² = 20.61 2.2 to 5.3 <0.001 Physical activity Sedentary 41 (50.0) 36 (30.5) χ² = 7.48 1.2 to 2.9 0.006 Obesity (BMI ≥25) Yes 56 (68.3) 49 (41.5) χ² = 13.94 1.6 to 4.0 <0.001 Knee injury history Yes 22 (26.8) 11 (9.3) χ² = 11.22 1.8 to 6.4 0.001 Hypertension Present 38 (46.3) 35 (29.7) χ² = 5.69 1.1 to 2.7 0.017 Table 3 presents the association between various demographic, lifestyle, occupational, and clinical risk factors and the presence of osteoarthritis. Participants aged 60 years and above constituted a significantly higher proportion of osteoarthritis cases (59.8%) compared to those without osteoarthritis (27.1%), indicating a strong age-related association (p <0.001). Sedentary physical activity was observed in 50.0% of participants with osteoarthritis, which was significantly higher than in those without osteoarthritis (30.5%) (p = 0.006). Obesity (BMI ≥25 kg/m²) showed a strong and statistically significant association with osteoarthritis, being present in 68.3% of cases compared to 41.5% of non-cases (p <0.001). A history of knee injury was also significantly associated with osteoarthritis, reported in 26.8% of affected participants versus 9.3% of unaffected participants (p = 0.001). Furthermore, hypertension was more prevalent among osteoarthritis cases (46.3%) compared to those without osteoarthritis (29.7%), demonstrating a significant association (p = 0.017). Table 4: Comparison of Risk Factors Between Urban and Rural Study Participants (N = 200) Risk Factor Urban n (%) (n=102) Rural n (%) (n=98) Test of Significance 95% CI p-value Mean age (years) 52.4 ± 9.1 58.2 ± 8.8 t = 4.69 3.4 to 8.2 <0.001 Occupational strain 31 (30.4) 65 (66.3) χ² = 25.48 2.3 to 6.1 <0.001 Obesity 47 (46.1) 58 (59.2) χ² = 3.52 0.9 to 2.4 0.061 Sedentary lifestyle 53 (52.0) 24 (24.5) χ² = 16.94 1.7 to 4.1 <0.001 OA prevalence 34 (33.3) 48 (49.0) χ² = 9.37 1.3 to 2.8 0.002 Table 4 compares the distribution of major risk factors between urban and rural participants. The mean age of rural participants was significantly higher than that of urban participants (58.2 ± 8.8 years vs. 52.4 ± 9.1 years), indicating an older rural population (p <0.001). Occupational strain was substantially more prevalent among rural participants (66.3%) compared to urban participants (30.4%), and this difference was highly significant (p <0.001). Although obesity was more common in rural participants (59.2%) than urban participants (46.1%), this difference did not reach statistical significance (p = 0.061). A sedentary lifestyle was significantly more prevalent in the urban population (52.0%) compared to the rural population (24.5%) (p <0.001). Importantly, the prevalence of osteoarthritis was significantly higher among rural participants (49.0%) compared to urban participants (33.3%), confirming a statistically significant rural predominance of osteoarthritis (p = 0.002).

The present cross-sectional study evaluated the prevalence of osteoarthritis (OA) and its associated risk factors among urban and rural populations. The overall prevalence of osteoarthritis in the study population was 41.0%, which is comparable to prevalence figures reported in Indian community-based studies ranging from 28% to 45% depending on age group and diagnostic criteria used. Pal Nehete YB et al. (2024)[5] similarly reported a high burden of osteoarthritis in Indian adults, highlighting OA as a major cause of musculoskeletal morbidity. Age and Sex as Risk Factors: As shown in Table 1 and Table 3, increasing age emerged as a strong and statistically significant risk factor for osteoarthritis. Participants with OA had a significantly higher mean age (59.3 ± 8.6 years) compared to those without OA, and nearly 60% of OA cases were aged ≥60 years. These findings are consistent with studies by Mesa‐Castrillon CI et al. (2024)[6], which demonstrated that age-related cartilage degeneration, reduced reparative capacity, and cumulative mechanical stress contribute to OA progression. Female predominance observed in the present study aligns with earlier Indian and global studies, where post-menopausal hormonal changes and differences in joint anatomy have been implicated in higher OA prevalence among women. Obesity, BMI, and Metabolic Factors: Higher BMI was significantly associated with osteoarthritis, with OA patients showing a markedly higher mean BMI compared to non-OA participants. Obesity was present in more than two-thirds of OA cases, corroborating findings from Lee DY. (2024)[7], who emphasized the role of both mechanical overload and metabolic inflammation in OA pathogenesis. The significant association between diabetes mellitus and osteoarthritis in the present study further supports the concept of “metabolic osteoarthritis,” as reported by Kurniari PK et al. (2025)[8], where insulin resistance and chronic low-grade inflammation accelerate joint degeneration. Occupational Strain and Physical Activity: Occupational strain was significantly higher among OA patients and was predominantly observed in rural participants (Table 4). This finding is consistent with studies by Siripongpan A et al. (2022)[9], which reported higher OA prevalence among individuals engaged in physically demanding occupations involving squatting, kneeling, and heavy lifting. In contrast, sedentary lifestyle was significantly more prevalent among urban participants and was also associated with OA, reflecting the dual burden of mechanical overuse in rural populations and physical inactivity-related obesity in urban populations. Urban–Rural Differences in OA Prevalence: Table 2 and Table 4 clearly demonstrate a significantly higher prevalence of osteoarthritis in the rural population (49.0%) compared to the urban population (33.3%). Similar rural predominance has been reported in Indian studies by Messier SP et al. (2025)[10], which attributed this difference to occupational load, delayed healthcare access, and lack of preventive interventions in rural settings. Although obesity was numerically higher in rural participants, the difference did not reach statistical significance, suggesting that occupational and age-related factors may play a more dominant role in rural OA burden. Clinical Risk Factors: A history of knee injury and the presence of hypertension were significantly associated with osteoarthritis in the present study (Table 3). Previous joint injury has been consistently reported as a strong predictor of OA due to altered joint biomechanics and accelerated cartilage wear, as documented by Desilet LW et al. (2025)[11]. The association with hypertension supports growing evidence linking cardiovascular risk factors with osteoarthritis through shared inflammatory and vascular mechanisms.

This cross-sectional study highlights osteoarthritis as a highly prevalent musculoskeletal disorder affecting a substantial proportion of the adult population, with an overall prevalence of 41% in the study sample. The burden of osteoarthritis was significantly higher among rural participants compared to their urban counterparts, emphasizing the influence of occupational strain, advanced age, and delayed healthcare access in rural settings. Increasing age, female gender, higher body mass index, occupational strain, sedentary lifestyle, and comorbid conditions such as diabetes mellitus and hypertension were identified as significant risk factors for osteoarthritis. Rural populations demonstrated higher exposure to physically demanding activities, whereas urban populations exhibited a higher prevalence of sedentary behavior, reflecting distinct risk profiles in different residential settings. The findings underscore the multifactorial etiology of osteoarthritis and the need for population-specific preventive strategies. Early identification of modifiable risk factors, lifestyle modification, occupational ergonomics, and improved access to healthcare services may help reduce the burden of osteoarthritis and its associated disability, particularly in high-risk rural populations. LIMITATIONS OF THE STUDY 1. The cross-sectional design of the study limits the ability to establish causal relationships between osteoarthritis and its associated risk factors. 2. The diagnosis of osteoarthritis was based primarily on clinical assessment, and radiological confirmation was not uniformly performed for all participants. 3. The study sample was drawn from a single geographic region, which may limit the generalizability of the findings to other populations. 4. Self-reported information regarding physical activity, occupational strain, and previous joint injury may be subject to recall bias. 5. Potential confounding factors such as dietary patterns, genetic predisposition, and detailed biomechanical assessments were not evaluated.

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