Abstract
Objectives
Accurate data on the burden of rheumatoid arthritis (RA) are scarce, but critical in helping health care providers and decision makers to optimize clinical and public health strategies for disease management. We quantified the burden of RA in Ontario from 1996 to 2010 by age, sex and health planning region.
Methods
We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based cohort of all Ontarians with RA, to estimate the crude prevalence and incidence of RA among men and women, and by age group from 1996 to 2010. Burden by area of patient residence and rheumatology supply also were determined.
Results
The number of RA patients increased over time, from 42,734 Ontarians (0.5%) in 1996 to 97,499 (0.9%) in 2010. On average 5,830 new RA patients were diagnosed each year. In 2010, the burden was higher among females (1.3%) than males (0.5%) and increased with age, with almost half of all RA patients aged 65 years and older. The burden was higher in northern communities (1.0%) than in southern urban areas (0.7%). During the study period, the number of rheumatologists practicing in Ontario remained unchanged (approximately 160).
Conclusion
Over a 15-year period, the number of RA patients more than doubled with no concomitant increase in the number of practicing rheumatologists. We observed considerable regional variation in burden, with the highest rates observed in the north. Our findings highlight the need for regional approaches to the planning and delivery of RA care in order to manage the growing burden.
Key words: Rheumatoid arthritis, prevalence, incidence, health services
Résumé
Objectifs
Les données précises sur le fardeau de la polyarthrite rhumatoïde (PR) sont rares mais essentielles pour aider le personnel soignant et les décideurs à optimiser les stratégies cliniques et de santé publique en gestion des soins thérapeutiques. Nous avons chiffré le fardeau de la PR en Ontario de 1996 à 2010 selon l’âge, le sexe et la région de planification sanitaire.
Méthode
Nous avons utilisé la base de données administratives sur la polyarthrite rhumatoïde de l’Ontario (ORAD), une cohorte populationnelle validée de tous les Ontariens atteints de PR, pour estimer la prévalence et l’incidence brutes de la PR selon le sexe et le groupe d’âge de 1996 à 2010. Nous avons aussi déterminé le fardeau de la maladie selon la région de résidence des patients et l’offre en rhumatologie.
Résultats
Le nombre de patients atteints de PR a augmenté avec le temps, passant de 42 734 Ontariens (0,5%) en 1996 à 97 499 (0,9%) en 2010. En moyenne, 5 830 nouveaux patients par année ont reçu un diagnostic de PR. En 2010, le fardeau était plus lourd chez les femmes (1,3%) que chez les hommes (0,5%), et il augmentait avec l’âge: près de la moitié des patients atteints de PR avaient 65 ans et plus. Le fardeau était plus lourd dans les communautés nordiques (1,0%) que dans les agglomérations urbaines du Sud (0,7%). Sur la période de l’étude, le nombre de rhumatologues exerçant en Ontario est resté inchangé (environ 160).
Conclusion
Sur une période de 15 ans, le nombre de patients atteints de PR a plus que doublé, sans augmentation comparable du nombre de rhumatologues en exercice. Nous avons relevé des écarts régionaux considérables dans le fardeau de la maladie, les plus hauts taux étant observés dans le Nord. Nos constatations soulignent le besoin d’approches régionales en matière de planification et de prestation des soins de la PR afin de composer avec l’alourdissement du fardeau.
Mots clés: polyarthrite rhumatoïde, prévalence, incidence, services de santé
Footnotes
Acknowledgements: Financial support provided by the Canadian Institutes of Health Research (CIHR operating grant 119348). This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), a non-profit research corporation funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. The authors also thank Simon Hollands and Peter Gozdyra of ICES for their contribution. Dr. Bernatsky holds a career award from the Fonds de la recherche en santé du Québec (FRSQ). Dr. Ivers holds a CIHR Fellowship Award in Clinical Research and a Fellowship Award from the Department of Family and Community Medicine, University of Toronto. Dr. Tu holds a CIHR Fellowship Award in Primary Care Research. Dr. Bombardier holds a Canada Research Chair in Knowledge Transfer for Musculoskeletal Care (2002–2016) and a Pfizer Research Chair in Rheumatology. We also thank Susan Jaglal, University of Toronto; and Dr. Jeffrey Curtis, University of Alabama at Birmingham for their external review.
Conflict of Interest: None to declare.
References
- 1.McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365:2205–19. doi: 10.1056/NEJMra1004965. [DOI] [PubMed] [Google Scholar]
- 2.Ozminkowski R, Burton W, Goetzel R, Maclean R, Wang S. The impact of rheumatoid arthritis on medical expenditures, absenteeism, and short-term disability benefits. J Occup Environ Med. 2006;48(2):135–48. doi: 10.1097/01.jom.0000194161.12923.52. [DOI] [PubMed] [Google Scholar]
- 3.Bykerk VP, Baron M, Boire G, Haraoui B, Khraishi M, LeClercq S, et al. J Can Rheumatol Assoc. 2004. Canadian Consensus Statement on Early Optimal Therapy in Early Rheumatoid Arthritis; pp. 11–13. [Google Scholar]
- 4.Widdifield J, Bernatsky S, Paterson JM, Thorne JC, Cividino A, Pope J, et al. Quality care in seniors with new-onset rheumatoid arthritis: A Canadian perspective. Arthritis Care Res. 2011;63:53–57. doi: 10.1002/acr.20304. [DOI] [PubMed] [Google Scholar]
- 5.Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying antirheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 2004;43:906–14. doi: 10.1093/rheumatology/keh199. [DOI] [PubMed] [Google Scholar]
- 6.Feldman DE, Bernatsky S, Houde M, Beauchamp ME, Abrahamowicz M. Early consultation with a rheumatologist for RA: Does it reduce subsequent use of orthopaedic surgery? Rheumatology (Oxford) 2013;52(3):452–59. doi: 10.1093/rheumatology/kes231. [DOI] [PubMed] [Google Scholar]
- 7.Widdifield J, Bernatsky S, Paterson JM, Tu K, Ng R, Thorne JC, et al. Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: A validation study using the medical records of rheumatologists. Arthritis Care Res (Hoboken) 2013;65(10):1582–91. doi: 10.1002/acr.22031. [DOI] [PubMed] [Google Scholar]
- 8.Widdifield J, Bombardier C, Bernatsky S, Paterson JM, Green D, Young J, et al. Accuracy of Canadian health administrative databases for identifying patients with rheumatoid arthritis: A validation study using the medical records of primary care physicians. 2012. [DOI] [PubMed] [Google Scholar]
- 9.Canadian Institute for Health Information. The CIHI Data Quality Framework. Ottawa, ON: CIHI; 2009. [Google Scholar]
- 10.Ontario Health Insurance Plan: The program. Toronto, ON: Ontario Ministry of Health and Long-Term Care, 2008. Available at: https://doi.org/www.health.gov.on.ca/en/public/programs/ohip/ (Accessed July 15, 2013).
- 11.Statistics Canada. Population counts for Canada, provinces and territories, census divisions and census subdivisions (municipalities), by urban and rural, 2011 Census: 100% data (table) Ottawa: Statistics Canada; 2011. [Google Scholar]
- 12.Improving health care data in Ontario. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2005. [Google Scholar]
- 13.Chan B, Schultz S. Supply and utilization of general practitioner and family physician services in Ontario. Toronto: Institute for Clinical Evaluative Sciences; 2005. [Google Scholar]
- 14.Badley EM, Canizares M, Mahomed N, Veinot P, Davis AM. Provision of orthopaedic workforce and implications for access to orthopaedic services in Ontario. J Bone Joint Surg Am. 2011;93:863–70. doi: 10.2106/JBJS.I.01782. [DOI] [PubMed] [Google Scholar]
- 15.Badley E, Veinot P, Ansari H, Mackay C, Thorne C. Arthritis Community Research and Evaluation Unit 2007 Survey of Rheumatologists in Ontario. 2008. [Google Scholar]
- 16.Statistics Canada. Land and freshwater area, by province and territory. 2005. [Google Scholar]
- 17.Hoovestol RA, Mikuls TR. Environmental exposures and rheumatoid arthritis risk. Curr Rheumatol Rep. 2011;13:431–39. doi: 10.1007/s11926-011-0203-9. [DOI] [PubMed] [Google Scholar]
- 18.Costenbader KH, Chang SC, Laden F, Puett R, Karlson EW. Geographic variation in rheumatoid arthritis incidence among women in the United States. Arch Intern Med. 2008;168:1664–70. doi: 10.1001/archinte.168.15.1664. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Vieira VM, Hart JE, Webster TF, Weinberg J, Puett R, Laden F, et al. Association between residences in U.S. northern latitudes and rheumatoid arthritis: A spatial analysis of the Nurses’ Health Study. Environ Health Perspect. 2010;118:957–61. doi: 10.1289/ehp.0901861. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Kobayashi KM, Prus SG. Examining the gender, ethnicity, and age dimensions of the healthy immigrant effect: Factors in the development of equitable health policy. Int J Equity Health. 2012;11:8. doi: 10.1186/1475-9276-11-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Cott CA, Gignac MA, Badley EM. Determinants of self rated health for Canadians with chronic disease and disability. J Epidemiol Community Health. 1999;53:731–36. doi: 10.1136/jech.53.11.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Rural and northern health care framework. 2011. Available at: https://doi.org/www.health.gov.on.ca/en/public/programs/ruralnorthern/docs/report_rural_northern_EN.pdf (Accessed July 15, 2013).
- 23.Chronic Disease Surveillance Program. Chronic Diseases in the Métis Nation of Ontario. 2012. [Google Scholar]
- 24.Glazier RH, Moineddin R, Agha MM, Zagorski B, Hall R, Manuel DG, et al. The impact of not having a primary care physician among people with chronic conditions. Toronto: Insitute for Evaluative Sciences; 2008. [Google Scholar]
- 25.Schwalfenberg GK, Genuis SJ, Hiltz MN. Addressing vitamin D deficiency in Canada: A public health innovation whose time has come. Public Health. 2010;124:350–59. doi: 10.1016/j.puhe.2010.03.003. [DOI] [PubMed] [Google Scholar]
- 26.Wasko MC, Kay J, Hsia EC, Rahman MU. Diabetes mellitus and insulin resistance in patients with rheumatoid arthritis: Risk reduction in a chronic inflammatory disease. Arthritis Care Res (Hoboken) 2011;63:512–21. doi: 10.1002/acr.20414. [DOI] [PubMed] [Google Scholar]
- 27.Song GG, Bae SC, Lee YH. Association between vitamin D intake and the risk of rheumatoid arthritis: A meta-analysis. Clin Rheumatol. 2012;31(12):1733–39. doi: 10.1007/s10067-012-2080-7. [DOI] [PubMed] [Google Scholar]
- 28.Kyburz D, Gabay C, Michel BA, Finckh A, physicians of SCQM-RA The longterm impact of early treatment of rheumatoid arthritis on radiographic progression: A population-based cohort study. Rheumatology (Oxford) 2011;50:1106–10. doi: 10.1093/rheumatology/keq424. [DOI] [PubMed] [Google Scholar]
- 29.Ahern M, Smith M. Rheumatoid arthritis. Med J Australia. 1997;166:156–61. [PubMed] [Google Scholar]
- 30.Prevoo ML, van Gestel AM, van T Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Br J Rheumatol. 1996;35:1101–5. doi: 10.1093/rheumatology/35.11.1101. [DOI] [PubMed] [Google Scholar]
- 31.Bain L, Mierdel S, Thorne C. Modeling best practices in chronic disease management: The Arthritis Program at Southlake Regional Health Centre. J Allied Health. 2012;41:e83–e87. [PubMed] [Google Scholar]