Incidence of Corticosteroid and Hyaluronic Acid Injections and Risk of Hospitalization: A Population-Based Cohort Study (2010–2023)

Background: Intra-articular corticosteroid and hyaluronic acid injections are widely used for managing musculoskeletal disorders. Large-scale population-based data assessing the real-world safety of these injections remain limited. The current study evaluates long-term trends of these injections in the general population along with the incidence of acute subsequent hospitalizations. Methods: This was a retrospective, population-based cohort study using data from Clalit Health Services (CHS), Israel's largest health maintenance organization, between January 1, 2010 and December 31, 2023. Adult patients (≥18 years) who received at least one corticosteroid or hyaluronic acid injection were included. Data included demographics, injection characteristics, and clinical comorbidities. The primary outcome was hospitalizations within 30 days of injection due to infection or acute vascular event. Multivariable logistic regression was used to identify predictors of hospitalization. Results: The cohort included 404,797 patients with a mean age of 55±16 years; 55% were female. Injection rates increased from 10.5 to 20.9 per 1,000 individuals between 2010 and 2023. Despite a steady increase in overall injection numbers, hospitalization rates remained low and stable. The Charlson Comorbidity Index (CCI) was the only independent predictor of hospitalization in adjusted models (OR: 11.56; 95% CI: 1.09–122.25; p = 0.04). Conclusion: Despite increased utilization, hospitalization rates following injections remained low. Comorbidity burden, as measured by the Charlson Comorbidity Index, was the strongest predictor of adverse outcomes. These findings support the continued use of corticosteroid injections with careful patient selection and monitoring.