Exploring the link between comorbidities, tobacco usage, and surgical intervention in medial epicondylitis

Abstract Medial epicondylitis (ME), or golfer’s elbow, is a common musculoskeletal condition affecting the common flexor tendon, yet little is known about how comorbidities, including tobacco use, relate to its diagnosis and to the need for surgery. We retrospectively analyzed the Humana claims dataset within the PearlDiver database (approximately 8,000,000 patients) from 2007 to 2015 using ICD-9 and ICD-10 codes, identifying 23,573 patients with ME. All 1,657,810 patients with a diagnosis of tobacco use disorder were matched 1:1 to non-tobacco users by age, gender and comorbidity profile, and odds ratios were compared between the matched cohorts with significance set at p < 0.05. Tobacco users had slightly increased odds of an ME diagnosis (OR 1.05, 95% CI 1.01–1.10, p = 0.006) and more clearly increased odds of undergoing surgical intervention for ME (OR 1.62, 95% CI 1.25–2.08, p = 0.0002). ME was most frequently recorded in patients aged 60 to 69 years, and the most common comorbidities were hypertension and hyperlipidemia. Tobacco use was recorded more often among patients who underwent surgery than in the total ME population (30.10% vs. 23.69%, p = 0.009), whereas hypertension was recorded less often (50.48% vs. 58.66%, p = 0.048). These claims-based findings describe associations and cannot establish causation.