{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:37:34Z","timestamp":1790833054172,"version":"4.1.0"},"reference-count":28,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Elly Olsson's Foundation for Medical Research","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"ALF grants Region Sk\u00e5ne","award":["2022-0129"],"award-info":[{"award-number":["2022-0129"]}]},{"name":"Stig and Ragna Gorthon Foundation","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/501100011077","name":"Sk\u00e5nes universitetssjukhus","doi-asserted-by":"publisher","award":["[2022-974]"],"award-info":[{"award-number":["[2022-974]"]}],"id":[{"id":"10.13039\/501100011077","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006738","name":"Medicinska Fakulteten, Lunds Universitet","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100006738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,7]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the associations between socioeconomic position (SEP) and the incidence of serious hand infections\u2014pyogenic flexor tenosynovitis (PFT) and septic arthritis (SA)\u2014as well as risks of opioid overuse following diagnosis using nation-level data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>In a registry-based nationwide retrospective cohort study, (1) associations between SEP and incidence of PFT\/SA; (2) SEP and infection-type effects on opioid overuse in the general population and (3) SEP and clinical predictors of opioid overuse among individuals diagnosed with PFT\/SA were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and outcome measures<\/jats:title>\n                    <jats:p>Using linked Swedish national registers (2010\u20132015), (1) a multinomial regression to assess SEP and infection risk (n=5 697 865); (2) logistic regression on opioid overuse (\u22652 dispensations within 3 months) related to SEP and infection status and (3) a restricted analysis among diagnosed individuals (n=3701) to isolate clinical determinants of opioid overuse was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the study population, 0.04% had PFT and 0.02% had SA. In the general population, 0.31% received two or more opioid prescriptions, compared with 4.5% of those with PFT and 6.8% of those with SA. Male sex, older age, being native, low occupational qualification, comorbidity and\u2014specifically for SA\u2014low income were associated with higher infection risk. Both infections independently predicted opioid overuse (adjusted OR for PFT: 13.23 (95% CI 10.92 to 16.02); adjusted OR for SA: 15.16 (11.99 to 19.17)). Additional predictors of overuse included low SEP, female sex, older age, native birth, living alone and comorbidity. Infected individuals with SA were more likely to overuse opioids than those with PFT, but SEP had limited predictive power within this subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite universal healthcare, socioeconomic disparities exist in hand infection incidence and opioid prescribing. PFT and SA increase the risk of opioid overuse, but SE inequalities, except comorbidity, are less relevant among individuals. Targeted, equitable pain management strategies that reduce unnecessary opioid exposure while ensuring adequate care are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108329","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:30:23Z","timestamp":1769772623000},"page":"e108329","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Socioeconomic inequalities of the hand infections pyogenic flexor tenosynovitis and septic arthritis and risk of opioid overuse following diagnosis: a registry-based nationwide retrospective cohort study in Sweden"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-3152","authenticated-orcid":false,"given":"Karolin","family":"Lund\u00e9n","sequence":"first","affiliation":[{"name":"Department of Hand Surgery, Sk\u00e5ne University Hospital, Malm\u00f6, Sweden"},{"name":"Department of Translational Medicine \u2013 Hand Surgery, Lund University, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine \u2013 Hand Surgery, Lund University, Malm\u00f6, Sweden"},{"name":"Unit for Social Epidemiology, Department of Clinical Sciences (Malm\u00f6), Faculty of Medicine, Lund University, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9925-3838","authenticated-orcid":false,"given":"Malin","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine \u2013 Hand Surgery, Lund University, Malm\u00f6, Sweden"},{"name":"Department of Orthopedics, Helsingborg Hospital, Sk\u00e5ne University Hospital, Helsingborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8379-9708","authenticated-orcid":false,"given":"Juan","family":"Merlo","sequence":"additional","affiliation":[{"name":"Unit for Social Epidemiology, Department of Clinical Sciences (Malm\u00f6), Faculty of Medicine, Lund University, Malm\u00f6, Sweden"},{"name":"Center for Primary Health Research, Region Sk\u00e5ne, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-3099","authenticated-orcid":false,"given":"Lars B.","family":"Dahlin","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Sk\u00e5ne University Hospital, Malm\u00f6, Sweden"},{"name":"Department of Translational Medicine \u2013 Hand Surgery, Lund University, Malm\u00f6, Sweden"},{"name":"Department of Biomedical and Clinical Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026013003301685000_16.1.e108329.1","first-page":"26","article-title":"Low socioeconomic status worsens access to care and outcomes for rotator cuff repair: a scoping review","volume":"2","author":"Gatto","year":"2022","journal-title":"JSES Rev Rep Tech"},{"key":"2026013003301685000_16.1.e108329.2","doi-asserted-by":"crossref","first-page":"428","DOI":"10.2106\/JBJS.19.00504","article-title":"The Impact of Socioeconomic Status on Outcomes in Orthopaedic Surgery","volume":"102","author":"Li","year":"2020","journal-title":"J Bone Joint Surg Am"},{"key":"2026013003301685000_16.1.e108329.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30485-7"},{"key":"2026013003301685000_16.1.e108329.4","doi-asserted-by":"crossref","DOI":"10.1186\/s40249-023-01056-5","article-title":"Associations of socioeconomic status with infectious diseases mediated by lifestyle, environmental pollution and chronic comorbidities: a comprehensive evaluation based on UK Biobank","volume":"12","author":"Ye","year":"2023","journal-title":"Infect Dis Poverty"},{"key":"2026013003301685000_16.1.e108329.5","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1097\/SAP.0000000000004119","article-title":"Risk Factors for Developing Community-Acquired Hand Infections at a Large-Volume Urban Safety Net Hospital","volume":"93","author":"Yin","year":"2024","journal-title":"Ann Plast Surg"},{"key":"2026013003301685000_16.1.e108329.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30428-3"},{"key":"2026013003301685000_16.1.e108329.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2021.101198","article-title":"Global consumption of prescription opioid analgesics between 2009-2019: a country-level observational study","volume":"42","author":"Jayawardana","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2026013003301685000_16.1.e108329.8","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-43253-0","article-title":"Overuse of the psychoactive analgesics\u2019 opioids and gabapentinoid drugs in patients having surgery for nerve entrapment disorders","volume":"13","author":"Dahlin","year":"2023","journal-title":"Sci Rep"},{"key":"2026013003301685000_16.1.e108329.9","doi-asserted-by":"crossref","first-page":"355e","DOI":"10.1097\/01.prs.0000475788.52446.7b","article-title":"The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures: A National, Population-Based Study","volume":"137","author":"Waljee","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"2026013003301685000_16.1.e108329.10","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6610a1"},{"key":"2026013003301685000_16.1.e108329.11","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.jhsa.2018.10.014","article-title":"A Prospective, Randomized, Double-Blinded Controlled Trial Comparing Ibuprofen and Acetaminophen Versus Hydrocodone and Acetaminophen for Soft Tissue Hand Procedures","volume":"44","author":"Weinheimer","year":"2019","journal-title":"J Hand Surg Am"},{"key":"2026013003301685000_16.1.e108329.12","doi-asserted-by":"crossref","DOI":"10.5435\/JAAOSGlobal-D-19-00137","article-title":"Narcotic-Free, Over-the-Counter Pain Management After Wide-Awake Hand Surgery","volume":"3","author":"Sraj","year":"2019","journal-title":"JAAOS Glob Res Rev"},{"key":"2026013003301685000_16.1.e108329.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2014.03.031"},{"key":"2026013003301685000_16.1.e108329.14","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11133871","article-title":"Carpal Tunnel Syndrome and Ulnar Nerve Entrapment Are Associated with Impaired Psychological Health in Adults as Appraised by Their Increased Use of Psychotropic Medication","volume":"11","author":"Dahlin","year":"2022","journal-title":"J Clin Med"},{"key":"2026013003301685000_16.1.e108329.15","unstructured":"Statistics Sweden . MIS 2012:1, SSYK 2012 Swedish standard classification of occupations. 2012. Available: https:\/\/www.scb.se\/contentassets\/c9d055b6f2114b62bd23c33602b56da5\/ov9999_2012a01_br_x70br1201.pdf [Accessed 01 Jan 2022]."},{"key":"2026013003301685000_16.1.e108329.16","doi-asserted-by":"crossref","first-page":"04089","DOI":"10.7189\/jogh.14.04089","article-title":"A causal relationship between educational attainment and risk of infectious diseases: A Mendelian randomisation study","volume":"14","author":"Liu","year":"2024","journal-title":"J Glob Health"},{"key":"2026013003301685000_16.1.e108329.17","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1136\/ip.4.2.94","article-title":"Why are males injured more than females?","volume":"4","author":"Udry","year":"1998","journal-title":"Inj Prev"},{"key":"2026013003301685000_16.1.e108329.18","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01356"},{"key":"2026013003301685000_16.1.e108329.19","doi-asserted-by":"publisher","DOI":"10.1038\/nri3547"},{"key":"2026013003301685000_16.1.e108329.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2004.02.004"},{"key":"2026013003301685000_16.1.e108329.21","doi-asserted-by":"publisher","DOI":"10.1177\/0022146510383501"},{"key":"2026013003301685000_16.1.e108329.22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/ejp.2163","article-title":"Socioeconomic risk factors for long-term opioid use: A national registry-linkage study","volume":"28","author":"Nestvold","year":"2024","journal-title":"Eur J Pain"},{"key":"2026013003301685000_16.1.e108329.23","doi-asserted-by":"publisher","DOI":"10.1097\/00002508-200209000-00003"},{"key":"2026013003301685000_16.1.e108329.24","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.180646"},{"key":"2026013003301685000_16.1.e108329.25","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.10223","article-title":"Opioid Prescription Patterns and Risk Factors Associated With Opioid Use in the Netherlands","volume":"2","author":"Bedene","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026013003301685000_16.1.e108329.26","doi-asserted-by":"crossref","DOI":"10.1111\/bcpt.70040","article-title":"Trends in Postoperative Opioid Use in Norway 2011-2018: A Nationwide Registry-Based Study","volume":"136","author":"Samuelsen","year":"2025","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"2026013003301685000_16.1.e108329.27","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1097\/BRS.0000000000004710","article-title":"Persistent Use of Prescription Opioids Before and After Lumbar Spine Surgery","volume":"48","author":"Holmberg","year":"2023","journal-title":"Spine (Phila Pa 1986)"},{"key":"2026013003301685000_16.1.e108329.28","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2009.14"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-108329","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T11:30:26Z","timestamp":1769772626000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-108329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,30]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjopen-2025-108329"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-108329","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}