1155016 JFM Journal of Feline Medicine and SurgeryO’Neill et al

Original Article

Journal of Feline Medicine and Surgery

Commonly diagnosed disorders in 1­–9

© The Author(s) 2023
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DOI: 10.1177/1098612X231155016
https://doi.org/10.1177/1098612X231155016

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Dan G O’Neill1 , Danièlle Gunn-Moore2, Stephanie Sorrell3,

Harriet McAuslan1, David B Church4, Camilla Pegram1
and Dave C Brodbelt1

Abstract
Objectives The objectives of this study were to generate a robust evidence base on the prevalence of common
disorders in cats and develop a deeper understanding of disorder associations with sex and age that could offer
important opportunities for targeted veterinary care to improve feline health and welfare.
Methods A random sample of 18,249 cats was obtained from 1,255,130 cats under primary care during 2019 within
VetCompass, an epidemiological research programme based on anonymised primary care veterinary clinical records.
All disorders recorded during 2019 were extracted and reported, and associations with sex and age were examined.
Results The most prevalent disorders were periodontal disease (n = 2780 [15.2%], 95% confidence interval
[CI] 14.72–15.76), obesity (n = 2114 [11.6%], 95% CI 11.12–12.06) and dental disease (n = 1502 [8.2%], 95%
CI 7.84–8.64). Compared with male cats, females had an increased prevalence of poor quality of life, postoperative
complications and hyperthyroidism, among others. Male cats had a higher prevalence of periodontal disease, road
traffic accident (RTA) and obesity. Younger cats (<8 years) had an increased prevalence of cat bite abscess, flea
infestation and RTA, while older cats (⩾8 years) had increased prevalence of lameness, cystitis and dental disease,
among others.
Conclusions and relevance These findings suggest that the veterinary profession needs to engage more effectively
in informing owners on common preventable disorders (ie, obesity and dental disease). This new information can
contribute to more targeted health surveillance and more effective veterinary interventions to promote improved
health and welfare in pet cats. Large-scale collection and analysis of anonymised veterinary clinical records offer
an important clinical resource for research.

Keywords: Breed; electronic patient record; EPR; epidemiology; pedigree; purebred; primary care; veterinary;
VetCompass

Accepted: 18 January 2023

1Pathobiology and Population Sciences, The Royal Veterinary

Introduction College, Hawkshead Lane, North Mymms, Hatfield, UK
There are approximately 10.7–12.2 million cats in the UK, 2The Royal (Dick) School of Veterinary Studies and The Roslin

with 27% of UK households estimated to own at least one Institute, University of Edinburgh, Easter Bush Campus,
cat.1,2 The close human–animal bonds shared between Midlothian, UK
3The Mindful Vet, Droitwich, UK
cats and their owners in these households support mutu- 4Clinical Science and Services, The Royal Veterinary College,
ally beneficial and dynamic relationships that are influ- Hawkshead Lane, North Mymms, Hatfield, UK
enced by several behaviours essential to good health and
well-being in both species.3 Going beyond just the mere Corresponding author:
Dan G O’Neill MVB, BSc(Hons), MSc(VetEpi), PhD, FRCVS,
presence of a cat in the household, physical, emotional
Pathobiology and Population Sciences, The Royal Veterinary
and social interactions with their pet cat have been shown College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire
to reduce measurable negative moods, anxiety, depres- AL9 7TA, UK
sion and introversion in people.4,5 However, conversely, Email: [email protected]

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2 Journal of Feline Medicine and Surgery 

it is also legally and ethically incumbent on owners and disorder risk associated with age and sex suggests that
keepers to care for their animals’ physical and mental these factors could be used to support improved preven-
health.6 A key element towards fulfilling this caregiver tive strategies, earlier recognition and enhanced clinical
role is for owners to have a thorough grasp of the fre- management with improved QoL for affected cats.
quency of common medical conditions that may affect With this broad background, the current study aimed
their animals.7 For example, greater sharing of aware- to report the prevalence of common disorders in cats
ness that disorders such as dental disease and obesity under primary veterinary care during 2019 in the UK,
are common but largely preventable diseases could sup- and to explore associations between common disorders
port owners in taking more proactive approaches to their with sex and age. The paper highlights opportunities for
cat’s healthcare, under the guidance of their veterinary veterinary professionals (veterinary surgeons and veteri-
practice.8 Furthermore, a deeper understanding of how nary nurses) to focus on recognising age and sex effects
sex and age differentially affect disorder risk should allow on disorder risk for targeted healthcare approaches and
owners to make better informed decisions, both when they supports the benefits of engaging owners within preven-
are choosing a cat in the first place and later, during owner- tive healthcare programmes, with a particular focus on
ship.9 For example, previous studies have documented an dental health and weight control.
increased risk of road traffic accidents (RTAs) in young
male cats.10 Consequently, with this information to hand, Materials and methods
owners living on a busy road may elect to acquire an The study population included all cats under primary
older cat or a female cat to reduce the probability of their veterinary care at clinics participating in the VetCompass
cat having an RTA. Programme in 2019. Cats under veterinary care were
Quality of life (QoL) can be challenging for owners defined as those with at least one electronic patient record
to interpret accurately in cats. For example, while osteo- (EPR; free-text clinical note, treatment or body weight)
arthritis (OA) is reportedly a relatively common prob- recorded in 2019. VetCompass is an epidemiological
lem in cats, being formally diagnosed in 2.0% of cats,11 research programme that collates and investigates de-
overt lameness is not its most common clinical feature.12 identified EPR data from primary care veterinary prac-
Instead, the main clinical signs are changes in behaviour tices across the UK.20 Relevant data fields available to
and lifestyle, which develop gradually but which own- VetCompass researchers include a unique animal identi-
ers often interpret as simply reflecting typical ‘old age’.13 fier along with veterinary group identifier, species, breed,
Overt signs of pain are less commonly exhibited because date of birth, sex and neuter status, along with clinical
cats have evolved to hide signs of illness as an adapta- information from free-form text clinical notes and treat-
tion to being both a prey animal, as well as a predator.14 ment with relevant dates.
Hence, while pain associated with OA may significantly A retrospective cohort study design was used to esti-
reduce a cat’s QoL, limited owner awareness of the high mate the 1-year (2019) period prevalence of the most
prevalence of OA in older cats may often result in fail- commonly diagnosed disorders. Sample size calcula-
ure to seek veterinary care.15 Greater awareness of age- tions estimated that 11,932 cats were needed to report
specific disorder risks can therefore promote enhanced the prevalence for a disorder occurring in 2.0% of cats
access to veterinary care that could be followed by the use with 0.25% margin of error at a 95% confidence level (CI)
of questionnaires such as the Feline Musculoskeletal Pain from a population of 1,255,130 cats.21 Ethical approval
Index (FMPI) for the evaluation of OA-associated pain to was obtained from The Royal Veterinary College Ethics
help with the recognition and alleviation of pain.16 and Welfare Committee (reference number SR2018-1652).
Over their lifetime, domestic animals experience The study design, data extraction and analysis
varying risk levels of developing a wide range of indi- methods followed those that have been previously pub-
vidual disorders.17 Deeper understanding of how dis- lished.11,17,22 A random sample of 18,249 cats was obtained
order risk varies according to age and sex can allow for from the overall sampling frame of all cats under veteri-
more targeted prophylaxis, detection and interventions.18 nary care in 2019. These cats were randomly ordered, and
Previous work has indicated that periodontal disease, flea all information in the EPR relating to 2019 was manu-
infestation and obesity are, overall, the most common dis- ally reviewed to extract the most definitive diagnoses
orders in cats.11 However, there is evidence for increasing recorded for all disorders that existed during 2019.17 The
risk with advancing age across several individual dis- EPRs were accessed via the VetCompass online user inter-
orders, as well as for multimorbidity; for example, OA, face (VetCompass.org) and the manual review process
chronic kidney disease (CKD), dental disease, hyperthy- was carried out by six final-year veterinary undergrad-
roidism and/or feline dementia (also known as cogni- uate students under the direct supervision of the lead
tive dysfunction syndrome).9 Disorder risk has also been author (DGON).
shown to vary by sex in cats; for example, there are higher Each disorder event was followed over time in the
odds of RTA in male cats after accounting for the effects cohort data source to identify the most definitive diag-
of neuter status, age, breed and season.19 Differential nosis terms recorded, and to verify that the diagnosis
O’Neill et al 3

had not been revised over time. The VetCompass system Results
does not require veterinary surgeons to code diagnoses Demography
or to make any changes to their preferred note-making From an available population of 1,255,130 cats under vet-
styles at the point of veterinary care. The notes and other erinary care across six multi-clinic veterinary groups and
clinical information routinely recorded during episodes partnerships in the UK during 2019, the current study
of veterinary care are examined later by VetCompass included a random sample of 18,249 (1.4%) cats. The
researchers to extract information on targeted research study sample cats included 9141 (50.1%) females and
questions. Every distinct disorder with evidence for 8944 (48.5%) males. The median age of the overall study
existence within the clinical records was coded to the sample of cats was 5.67 years (range 0.03–23.90; inter-
most precise diagnostic or descriptive term available in quartile range [IQR] 2.39–10.32). Females (median 5.76
the VeNom coding system.23 Disorders described in the years [range 0.03–23.90; IQR 2.48–10.63]) were statisti-
clinical notes using presenting sign terms (eg, ‘vomit- cally younger than males (median 5.59 years [range 0.05–
ing’ or ‘vomiting and diarrhoea’), but without a formally 23.26; IQR 2.33-9.94]; P <0.001). The median adult body
recorded clinical diagnostic term, were included using weight of the overall study sample of cats was 5.50 kg
the first sign listed (eg, vomiting). The extracted diagno- (range 1.50–15.00; IQR 3.99–7.40). The median adult body
sis terms were mapped to a dual hierarchy of diagnostic weight of females (5.49 kg [range 1.50–15.00; IQR 3.95–
precision for analysis – precise-level and grouped-level 7.39]) did not differ statistically compared with males
– as previously described.24 Briefly, precise-level terms (5.50 kg [range 1.50–15.00; IQR 4.00–7.43]; P = 0.449). Of
described the original extracted terms at the maximal the 18,005 cats with breed information recorded, 12.0%
diagnostic precision recorded within the clinical notes (n = 2164) were classified as purebred. The most com-
(eg, inflammatory bowel disease [IBD] would remain as mon pure breeds were British Shorthair (n = 542; 3.0%),
IBD). Grouped-level terms mapped the original diagnosis Ragdoll (n = 328; 1.8%), Bengal (n = 219; 1.2%), Maine
terms to a general level of diagnostic precision (eg, IBD Coon (n = 168; 0.9%), Persian (n = 131; 0.7%) and Siamese
would map to enteropathy). Data on elective (eg, neu- (n = 123; 0.7%), and there were 15,841 (88.0%) crossbred
tering) or prophylactic (eg, vaccination) clinical events cats. Data completeness for the variables in the study
themselves were not recorded, but any disorders identi- sample was as follows: breed 98.7%, sex 99.1%, neuter
fied during such clinical examinations were included. No status 99.1%, age 98.3% and adult body weight 61.5%.
distinction was made between pre-existing and incident
disorder presentations. Summary disorder occurrence
Following data checking for internal validity and From the random sample of 18,249 cats with data extracted
cleaning in Microsoft Excel, analyses were conducted on all recorded disorders for 2019, 12,042 (66.0%) had at
using Stata Version 16. Breed descriptive information least one disorder recorded during 2019. The EPR of the
entered by the participating practices was cleaned and remaining 6207 (34.0%) cats had zero disorders recorded
mapped to a VetCompass breed list derived and extended in 2019 and mainly presented for prophylactic clinical
from the VeNom Coding breed list.23 A purebred vari- care. The proportion of male cats (67.5%) with at least one
able categorised cats of recognisable breeds as ‘purebred’, disorder recorded was statistically higher compared with
and cats recorded as mixes of breeds or without breed females (64.6%; P <0.001). The median age of cats with at
information as ‘non-purebred’.25 Sex and neuter status least one disorder recorded (6.88 years [range 0.03–23.90;
were defined by the final available EPR value. Adult body IQR 3.05–11.48]) was older than for cats that had zero
weight was defined as the average (mean) of all body disorders recorded (3.77 years [range 0.03–23.80; IQR
weight (kg) values recorded for each cat after reaching 1.63–7.64]; P <0.001).
9 months old. Age (years) was defined at 31 December The median annual disorder count per cat during
2019 as the final date by which each cat in the cohort was 2019 was one disorder (range 0–15; IQR 0–2). The median
classified as either a case or a non-case for each disorder. annual disorder count was statistically higher in males
Cats were categorised by age as younger (<8.0 years) and (1 [range 0–15; IQR 0–2]) compared with females (1 [range
older (⩾8.0 years). 0–14; IQR 0–2]; P <0.001). The median disorder count was
One-year period prevalence values with 95% CIs higher in older (⩾8.0 years) cats (2 [range 0–15; IQR 1–3])
described the probability of diagnosis at least once dur- than in younger (<8.0 years) cats (1 [range 0–13; IQR 0–2];
ing 2019. CI estimates were derived from standard errors P <0.001).
based on approximation to the binomial distribution.26
The median age (years) across all affected animals was Precise-level disorder occurrence
reported. Prevalence values were reported overall and Across the 18,249 study cats, there were 25,891 unique
separately for females and males. Univariable compari- disorder events recorded during 2019, encompassing 641
sons used the χ2 test to compare categorical variables and distinct precise-level disorder terms. The most prevalent
the Mann–Whitney U-test to compare continuous vari- precise-level precision disorders recorded were peri-
ables.26 Statistical significance was set at the 5% level. odontal disease (n = 2780 [15.2%], 95% CI 14.72–15.76),
4 Journal of Feline Medicine and Surgery 

obesity (n = 2114 [11.6%], 95% CI 11.12–12.06), dental years) cats for all 30 of the most common grouped-level
disease (n = 1502 [8.2%], 95% CI 7.84–8.64), overgrown disorders. Younger cats had a higher prevalence than
nail(s) (n = 954 [5.2%], 95% CI 4.91–5.56), flea infestation older cats for five disorders: adverse reaction to drug,
(n = 926 [5.1%], 95% CI 4.76–5.40) and heart murmur viral infectious disorder, complication associated with
(n = 811 [4.4%], 95% CI 4.15–4.75) (Table 1). clinical care, parasite infestation and traumatic injury.
Among the 30 most common precise-level disorders, Older cats had higher prevalence for the remaining 25
the prevalence differed between the sexes for 14 (46.7%) disorders (Table 2).
disorders. Females had a statistically higher prevalence
than males for six disorders: poor QoL, postoperative Discussion
wound complication, overgrooming, flea bite hypersensi- This is the largest study to date to use general practice
tivity, overgrown nail(s) and hyperthyroidism. Males had veterinary data to report the prevalence of commonly
higher prevalence than females for eight disorders: peri- diagnosed disorders in cats in the UK. A study using a
odontal disease, RTA, heart murmur, lameness, obesity, similar methodology was published in 2013; however,
abscess, wound and cat bite injury. it included only 3584 cats vs 18,249 cats in the current
The median age of cats recorded with each of the 30 study.11 The present study used anonymised veterinary
most common precise-level disorders varied from 1.67 clinical data from the VetCompass programme20 to report
years for postoperative wound complication to 16.78 the frequencies of common disorders of cats under gen-
years for poor QoL. Among the 30 most common pre- eral veterinary care in the UK in 2019. The prevalence for
cise-level disorders, the prevalence differed between each disorder was reported at a refined level of diagnostic
the younger (<8 years) and older (⩾8 years) cats for 27 precision (the precise level) and at a more general level
(90.0%) disorders. Younger cats had higher prevalence of diagnostic precision (the grouped level). The study
than older cats for four disorders: cat bite injury, flea placed special focus on disorder associations with sex
infestation, RTA and postoperative wound complica- and age.
tion. Older cats had higher prevalence for 23 disorders: The results suggest an increase in the proportion of
lameness, abscess, cystitis, overgrooming, dental disease, purebred cats in the UK, increasing from 11.0% in 2013 to
constipation, thin/underweight, OA, haircoat disorder, 12.0% in 2019, and also a change in the relative popular-
anorexia, otitis externa, vomiting, cardiac dysrhythmia, ity of some breeds, with Ragdolls now the second most
weight loss, CKD, disorder not diagnosed, periodontal popular pure breed in the UK and Persian cats dropping
disease, poor QoL, heart murmur, flea bite hypersensi- to fifth place.11 Given the growing awareness of health
tivity, obesity, overgrown nail(s) and hyperthyroidism and welfare issues associated with severe brachycephaly
(Table 1). in companion animal species and growing public calls
to ‘stop and think before buying a flat-faced animal’,27,28
Grouped-level disorder occurrence it is reassuring for animal welfare to see a reduction in
The study included 67 distinct grouped-level disor- the ownership of the severely brachycephalic Persian
der terms. The most prevalent were dental disorder breed with its documented health issues,29 with choice of
(n = 3870 [21.2%], 95% CI 20.62–21.81), obesity (n = 2114 pure breed ownership potentially moving to the Ragdoll,
[11.6%], 95% CI 11.12–12.06), skin disorder (n = 1757 which is only mildly brachycephalic.
[9.6%], 95% CI 9.20–10.07), enteropathy (n = 1552 [8.5%], The most prevalent disorders diagnosed in cats in 2019
95% CI 8.10–8.92), parasite infestation (n = 1150 [6.3%], were periodontal disease (15.2%), obesity (11.6%) and
95% CI 5.95–6.66) and heart disease (n = 1093 [6.0%], 95% dental disease (8.2%). These findings are of particular
CI 5.65–6.34) (Table 2). note as comparison with a 2013 study that used a simi-
Among the 30 most common grouped-level disor- lar data source suggests an increase in the prevalence of
ders, the prevalence differed between the sexes for 12 dental disease (at a grouped level from 15.1% to 21.2%),
(40.0%) disorders. Females had higher prevalence than with periodontal disease increasing at a precise-level
males for three disorders: complication associated with diagnosis from 13.9% to 15.2%. At the group level, obe-
clinical care, claw/nail disorder and endocrine system sity increased from 6.7% to 11.6%.11 The median age of
disorder. Males had higher prevalence than females for the cats also rose from 4.50 years to 5.67 years between
nine disorders: heart disease, parasite infestation, upper the time of the two studies, with an increase in the pro-
respiratory tract disorder, adverse reaction to drug, viral portion of purebred cats from 11.0% to 12.0%, as well
infectious disorder, obesity, traumatic injury, abscess and as some changes in the proportions of particular cat
oral cavity disorder. breeds (see below). However, it is noteworthy that there
The median age of cats recorded with each of the 30 were some methodological differences between the two
most common grouped-level disorders varied from 1.67 studies that may have accounted for some of these dif-
years for postoperative wound complication to 15.15 ferences. For example, the current study included only
years for endocrine system disorder. The prevalence diagnoses recorded during a single year of clinical care
differed between the younger (<8 years) and older (⩾8 (2019), whereas the earlier study included all diagnoses
Table 1 Prevalence of the 30 most common disorders at a precise-level of diagnostic precision recorded in cats (n = 18,249) under general practice veterinary care
at UK practices participating in the VetCompass programme from 1 January to 31 December 2019
O’Neill et al

Precise-level disorder term n (%) 95% CI F (%) M (%) F:M RR P value Younger Older Younger:older P value Median age
(sex) (%) (%) RR (age) (years)

Periodontal disease 2780 (15.2) 14.72–15.76 14.7 15.8 0.93 0.045 9.6 25.3 0.38 <0.001 9.47
Obesity 2114 (11.6) 11.12–12.06 10.8 12.4 0.87 0.001 10.9 13.1 0.84 <0.001 6.83
Dental disease 1502 (8.2) 7.84–8.64 8.2 8.3 0.98 0.741 5.8 12.7 0.46 <0.001 8.64
Overgrown nail(s) 954 (5.2) 4.91–5.56 5.9 4.6 1.27 <0.001 4.6 6.4 0.73 <0.001 6.79
Flea infestation 926 (5.1) 4.76–5.40 4.9 5.3 0.93 0.26 5.76 4.0 1.45 <0.001 3.62
Heart murmur 811 (4.4) 4.15–4.75 4.1 4.8 0.84 0.01 2.2 8.5 0.26 <0.001 11.67
Weight loss 699 (3.8) 3.56–4.12 4.0 3.6 1.12 0.148 1.2 8.5 0.14 <0.001 13.43
Vomiting 589 (3.2) 2.98–3.49 3.4 3.1 1.11 0.184 2.5 4.5 0.55 <0.001 8.26
Abscess 573 (3.1) 2.89–3.40 1.8 4.5 0.39 <0.001 2.9 3.6 0.81 0.011 6.74
Diarrhoea 522 (2.9) 2.62–3.11 2.8 3.0 0.93 0.406 3.0 2.7 1.12 0.206 3.14
Haircoat disorder 477 (2.6) 2.39–2.86 2.5 2.8 0.91 0.262 1.7 4.3 0.42 <0.001 9.24
Thin/underweight 397 (2.2) 1.97–2.40 2.3 2.1 1.11 0.315 0.9 4.3 0.22 <0.001 13.25
Wound 378 (2.1) 1.87–2.29 1.6 2.6 0.63 <0.001 2.2 1.9 1.18 0.119 5.55
Hyperthyroidism 350 (1.9) 1.72–2.13 2.4 1.5 1.64 <0.001 0.0 5.2 0.01 <0.001 15.37
Chronic kidney disease 333 (1.8) 1.64–2.03 2.0 1.6 1.21 0.082 0.2 4.6 0.05 <0.001 15.57
Anorexia 318 (1.7) 1.56–1.94 1.9 1.6 1.14 0.245 1.0 3.1 0.33 <0.001 10.72
Conjunctivitis 302 (1.6) 1.47–1.85 1.5 1.8 0.87 0.216 1.8 1.4 1.26 0.059 4.23
Disorder not diagnosed 286 (1.6) 1.39–1.76 1.4 1.7 0.81 0.081 0.7 2.9 0.26 <0.001 12.36
Flea bite hypersensitivity 266 (1.5) 1.29–1.64 1.7 1.2 1.44 0.003 1.2 1.9 0.60 <0.001 7.84
Osteoarthritis 252 (1.4) 1.22–1.56 1.5 1.3 1.14 0.301 0.1 3.7 0.02 <0.001 15.70
Cat bite injury 222 (1.2) 1.06–1.39 0.7 1.7 0.41 <0.001 1.4 1.0 1.33 0.047 5.64
Cystitis 202 (1.1) 0.96–1.27 1.1 1.1 1.08 0.578 0.9 1.5 0.64 0.001 7.71
Lameness 195 (1.1) 0.92–1.23 0.8 1.3 0.65 0.004 0.9 1.3 0.72 0.026 7.25
Postoperative wound 185 (1.0) 0.87–1.17 1.2 0.8 1.40 0.021 1.3 0.5 2.33 <0.001 1.67
complication
Cardiac dysrhythmia 183 (1.0) 0.86–1.16 1.1 0.9 1.23 0.158 0.3 2.3 0.12 <0.001 13.69
Otitis externa 170 (0.9) 0.80–1.08 0.8 1.0 0.82 0.193 0.7 1.4 0.50 <0.001 8.83
Overgrooming 167 (0.9) 0.78–1.06 1.1 0.7 1.53 0.006 0.7 1.2 0.61 0.001 7.57
Constipation 153 (0.8) 0.71–0.98 0.8 0.9 0.93 0.645 0.5 1.5 0.34 <0.001 10.45
Poor quality of life 153 (0.8) 0.71–0.98 1.0 0.7 1.41 0.037 0.1 2.1 0.03 <0.001 16.78
Road traffic accident 148 (0.8) 0.69–0.95 0.7 0.9 0.71 0.033 1.0 0.4 2.30 <0.001 4.16

P values reflect females vs males, and younger (<8 years) vs older (⩾8 years) cats
CI = confidence interval; F = female; M = male; RR = risk ratio
5
 6

Table 2 Prevalence of the 30 most common disorders at a grouped-level of diagnostic precision recorded in cats (n = 18,249) under general practice veterinary
care at UK practices participating in the VetCompass programme from 1 January to 31 December 2019

Grouped-level disorder term n (%) 95% CI F (%) M (%) F:M RR P value Younger Older Younger: P value Median age
(sex) (%) (%) older RR (age) (years)

Dental disorder 3870 (21.2) 20.62–21.81 20.7 21.8 0.95 0.081 14.2 33.8 0.42 <0.001 8.97
Obesity 2114 (11.6) 11.12–12.06 10.8 12.4 0.87 0.001 11.0 13.1 0.84 <0.001 6.83
Skin disorder 1757 (9.6) 9.20–10.07 10.0 9.2 1.08 0.078 8.1 12.4 0.65 <0.001 7.50
Enteropathy 1552 (8.5) 8.10–8.92 8.5 8.5 0.99 0.878 7.5 10.4 0.72 <0.001 6.65
Parasite infestation 1150 (6.3) 5.95–6.66 5.9 6.8 0.86 0.011 7.2 4.8 1.48 <0.001 3.48
Heart disease 1093 (6.0) 5.65–6.34 5.6 6.4 0.86 0.012 2.6 12.0 0.22 <0.001 12.31
Traumatic injury 1062 (5.8) 5.48–6.17 4.4 7.3 0.61 <0.001 6.4 4.8 1.32 <0.001 5.33
Claw/nail disorder 1052 (5.8) 5.43–6.11 6.4 5.2 1.23 0.001 5.0 7.2 0.69 <0.001 7.26
Thin/underweight 1017 (5.6) 5.24–5.92 5.9 5.2 1.13 0.052 2.1 11.7 0.18 <0.001 13.23
Ophthalmological disorder 879 (4.8) 4.51–5.14 4.6 5.0 0.93 0.274 4.1 5.9 0.70 <0.001 6.74
Musculoskeletal disorder 755 (4.1) 3.85–4.44 3.9 4.4 0.88 0.079 2.1 7.8 0.26 <0.001 11.99
Urinary system disorder 606 (3.3) 3.07–3.59 3.1 3.6 0.87 0.093 2.9 4.1 0.72 <0.001 7.32
Abscess 586 (3.2) 2.96–3.48 1.8 4.6 0.39 <0.001 2.9 3.6 0.81 0.011 6.74
Kidney disease 462 (2.5) 2.31–2.77 2.7 2.3 1.16 0.098 0.4 6.2 0.07 <0.001 15.11
Endocrine system disorder 452 (2.5) 2.26–2.71 2.9 2.1 1.36 0.001 0.1 6.6 0.02 <0.001 15.15
Appetite disorder 449 (2.5) 2.24–2.70 2.6 2.3 1.15 0.137 1.3 4.5 0.30 <0.001 11.37
Behavioural disorder 413 (2.3) 2.05–2.49 2.4 2.2 1.11 0.307 2.0 2.7 0.73 0.002 6.40
Mass/lump 413 (2.3) 2.05–2.49 2.3 2.2 1.07 0.499 0.9 4.6 0.20 <0.001 11.89
Upper respiratory tract 406 (2.2) 2.02–2.45 1.9 2.5 0.78 0.011 1.5 3.4 0.44 <0.001 9.38
disorder
Ear disorder 372 (2.0) 1.84–2.25 1.9 2.2 0.83 0.074 1.6 2.8 0.56 <0.001 8.20
Neoplasia 336 (1.8) 1.65–2.05 1.9 1.8 1.03 0.81 0.5 4.2 0.11 <0.001 13.47
Disorder not diagnosed 286 (1.6) 1.39–1.76 1.4 1.7 0.81 0.081 0.7 2.9 0.26 <0.001 12.36
Complication associated 267 (1.5) 1.29–1.65 1.7 1.2 1.45 0.002 1.8 0.8 2.19 <0.001 1.67
with clinical care
Lethargy 251 (1.4) 1.21–1.56 1.2 1.5 0.80 0.077 1.2 1.6 0.75 0.021 6.22
Lower respiratory tract 242 (1.3) 1.17–1.50 1.4 1.3 1.05 0.726 0.7 2.4 0.29 <0.001 11.48
disorder
Oral cavity disorder 229 (1.2) 1.10–1.43 0.9 1.5 0.61 <0.001 1.0 1.7 0.56 <0.001 8.11
Viral infectious disorder 207 (1.1) 0.99–1.30 0.9 1.3 0.68 0.006 1.3 0.9 1.43 0.023 4.14
Foreign body 176 (1.0) 0.83–1.12 0.9 1.1 0.84 0.228 0.8 1.2 0.68 0.01 7.61
Brain disorder 175 (1.0) 0.82–1.11 1.0 0.9 1.02 0.871 0.4 1.9 0.24 <0.001 12.46
Adverse reaction to drug 164 (0.9) 0.77–1.05 0.7 1.1 0.66 0.008 1.0 0.7 1.49 0.023 2.70

P values reflect females vs males, and younger (<8 years) vs older (⩾8 years) cats
CI = confidence interval; F = female; M = male; RR = risk ratio
Journal of Feline Medicine and Surgery 
O’Neill et al 7

recorded over a longer period (from September 2009 to of cat bite abscesses, flea infestation and RTA, while
15 January 2014), which may have artifactually increased older cats (⩾8 years old) were more likely to have more
the probability of diagnosis-making within individual than one disorder overall, including lameness, cystitis
cats. It is also possible that the standard of note-making and dental disease, among others. These results support
within veterinary clinical records may have changed over earlier evidence that cats tend to develop multimorbidi-
time and that these apparent differences in disorder fre- ties as they advance in years, such as lameness, hyper-
quency reflect more detailed record-making over time. thyroidism and CKD.37 Some of these sex associations
However, if correct, marked increases in the prevalence have been noted previously (eg, increased risk of RTA in
of dental/periodontal disease in just 6 years are concern- male cats vs females).19 In addition, the current study also
ing. Although gingivitis is considered a reversible condi- reports that male cats show increased risk of abscesses,
tion with adequate plaque control and thorough dental wounds and cat bite injuries that are all likely secondary
home care, gingivitis develops into periodontal disease to greater tendencies towards roaming and fighting in
as the disease progresses, and periodontitis is an essen- male cats than in females.38 The new information on sex
tially irreversible and progressive disease.30 Similarly, the and age predispositions provided in the current study can
development and recognition of obesity should be readily assist with the tailoring of preventive healthcare advice
apparent to owners, and represents another potentially to the specific age and sex of individual cats for greater
preventable and reversible disorder.8 effect. For example, owners of young male cats could be
An apparently rising UK prevalence of common dis- advised to keep these cats indoors or to introduce night
orders such as obesity and dental disease in cats not only curfews to prevent or reduce the risk of RTA and cat fight-
suggests direct harm to health, but may also predispose ing. Greater emphasis could be placed on ensuring older
affected cats to multimorbidities. For example, obesity cats are assessed for multimorbidities, with females in
is one of the main risk factors for feline type 2 diabetes particular being assessed for hyperthyroidism as soon as
mellitus31 mediated by insulin resistance,32 where insu- any weight loss is noted. When assessing older cats, ask-
lin sensitivity is reduced by >50% in obese cats vs lean ing owners to complete a short questionnaire exploring
cats.33 Obesity has also been associated with an increased the signs of OA and dementia could help to identify these
risk of dermatological issues, OA, cardiovascular dis- common conditions earlier (eg, the FMPI).16
ease, neoplasia and urolithiasis.34 Similarly, periodontal/ Understanding and leveraging the pet–owner bond
dental disease has been associated with direct oral pain is critical for improved delivery of effective preventive
and tooth loss, as well as systemic bacteraemia 30 and healthcare.39 Veterinary teams can play a key supporting
CKD.35 However, with good owner motivation and veter- role in ensuring good health is maintained in pet cats in
inary intervention, much of the suffering from these and their home environment in relation to disorders such as
other painful, debilitating and eventually life-limiting obesity and dental disease. Practical and innovative ways
conditions that are highly preventable could be avoided need to be developed to communicate more effectively
in pet cats.8 Obesity has grown to become one of the most with owners (eg, putting attention-grabbing informa-
significant health and welfare problems affecting pet cats tion about dental disease and obesity into kitten packs,
in developed countries worldwide, with up to 60% of pet and sharing reliable information on the high frequency
cats now being overweight or obese.8 There are many rea- and welfare impacts of these diseases, along with useful
sons for worldwide rising levels of overweight/obesity information on preventive actions that owners can take).
in pet cats, including increased neutering, ease of access Veterinary nurse clinics could be used more effectively at
of highly palatable calorie-dense foods, reduced activity early intervention points to promote better oral healthcare
and changes in the owner–cat bond.8 The older median and give advice about weight gain in pet cats.40 Movement
age of the cats in 2019 vs 2013 may also have contributed of standard vaccination protocols towards 3-yearly time
to rising obesity rates, with some previous evidence for frames may inadvertently reduce routine owner–veteri-
increased risk of obesity in cats possibly driven by reduc- nary contact, resulting in diminished levels of healthcare
ing metabolic rates with ageing.36 for cats, as well as a loss of veterinary revenue if own-
Consideration of health from the perspective of disor- ers do not perceive a financial value from health-check
ders with differential risk by sex and age could be used consultations in the absence of a vaccination.41 However,
to tailor preventive healthcare strategies and improve owners may be willing to attend nurse clinics that could
patient outcomes. In the current study, when looking at provide an important preventive healthcare service and
age- and sex-associated disorders, female cats had an identify cats that need referral for a full veterinary sur-
increased prevalence of poor QoL, postoperative com- geon consultation, thereby avoiding the patient being lost
plications (including post-spay issues) and hyperthy- from the practice and also allowing the clinic to recover
roidism, among other disorders, while males were more some of this lost revenue.
likely to have periodontal disease, RTA, heart murmur, The current study has some limitations. The par-
lameness, obesity and cat bite abscesses, among others. ticipating practices were a convenience sample of six
Younger cats (<8 years old) had an increased prevalence veterinary groups in the UK and therefore may not be
8 Journal of Feline Medicine and Surgery 

fully representative of all veterinary practices in the UK. Acknowledgements Thanks to Noel Kennedy (RVC) for
VetCompass continues to recruit practices, and future VetCompass software and programming development. We are
studies will increasingly represent more UK veterinary grateful to the following researchers, who assisted with data
practices. The quality and validity of EPR recording collection during this project: Alyx Blenkarn, Annabelle Lou-
relied on the clinical acumen and note-taking of individ- stric, Annie Mura, Harriet McAuslan, Kirstin Sutherland and
Rebecca Bostock. We acknowledge the Medivet Veterinary
ual practitioners. Many of the extracted disorder terms
Partnership, Vets4Pets/Companion Care, Goddard Veterinary
reflected the norms of primary care practice by repre-
Group, CVS Group, IVC Evidensia, Linnaeus Group, Beaumont
senting presenting signs (eg, lameness) recorded in lieu Sainsbury Animal Hospital, Blue Cross, PDSA, Dogs Trust,
of full, formal biomedical diagnoses. The use of these Vets Now and the other UK practices who collaborate in Vet-
terms might reflect the instigation by clinicians of empir- Compass. We are grateful to The Kennel Club Charitable Trust,
ical management protocols at the initial presentation of Agria Pet Insurance and The Kennel Club for supporting Vet-
common disorders, reducing the temporal and financial Compass. The data set supporting the conclusions of this article
burden of requiring a confirmed clinical diagnosis. It will be made available in the RVC Research Online repository.
is possible that the selection of the first sign from lists
with multiple presenting sign terms (eg, ‘vomiting and Conflict of interest The authors declared no potential
diarrhoea’) could have skewed the prevalence results at conflicts of interest with respect to the research, authorship,
the diagnosis level; however, this should not have mis- and/or publication of this article.
classified the results at the grouped level of precision.
Funding This study was supported at the RVC by an award
Neuter status was included in the analysis as recorded in
from the Kennel Club Charitable Trust and Agria Pet Insurance.
the originating clinical data; however, these values may
Neither the Kennel Club Charitable Trust nor Agria Pet Insur-
be falsely low because many veterinary practice man- ance had any input in the design of the study, the collection,
agement software systems apply a default neuter value analysis and interpretation of data, or in writing the manu-
of ‘entire’, which might not always be updated post- script.
neutering. The effects of neutering on disorder occur-
rence were not explored in the current study because Ethical approval The work described in this manuscript
neuter status is a time-dependent variable, and the tem- involved the use of non-experimental (owned or unowned)
poral order of disorder occurrence and neutering were animals. Established internationally recognised high standards
not extracted in the current study data. Some purebred (‘best practice’) of veterinary clinical care for the individual
and pedigree-cross cats might have been misclassified patient were always followed and/or this work involved the
in the EPR data. The number of cats from specific pure use of cadavers. Ethical approval from a committee was there-
fore not specifically required for publication in JFMS. Although
breeds was under-powered for statistically reliable
not required, where ethical approval was still obtained, it is
breed-based analyses.
stated in the manuscript.

Conclusions Informed consent Informed consent (verbal or written)

This study identified the most prevalent disorders of was obtained from the owner or legal custodian of all animal(s)
cats presented to general practice veterinary clinics described in this work (experimental or non-experimental
animals, including cadavers) for all procedure(s) undertaken
in the UK as periodontal disease, obesity and dental
(prospective or retrospective studies). For any animals or peo-
disease. Compared with results from a similar study
ple individually identifiable within this publication, informed
6 years earlier, the 2019 results suggest an increasing consent (verbal or written) for their use in the publication was
diagnosis rate of dental disease and obesity in UK pet obtained from the people involved.
cats. Several disorders were noted with differential
risk by age and sex, suggesting some useful welfare ORCID iD Dan G O’Neill https://orcid.org/0000-0003-
opportunities for veterinary professionals to target 1115-2723
tailored veterinary care to specific higher-risk groups
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