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Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

  • GBD 2021 Rheumatoid Arthritis Collaborators
  • , et al.
  • Royal Adelaide Hospital
  • The University of Sydney
  • Global Alliance for Musculoskeletal Health
  • University of Washington
  • University of British Columbia
  • Arthritis Research Canada
  • University of Melbourne
  • Royal Cornwall Hospitals NHS Trust
  • University of Toronto
  • Canadian Memorial Chiropractic College
  • Charité – Universitätsmedizin Berlin
  • Mashhad University of Medical Sciences
  • Rafsanjan University of Medical Sciences
  • Tehran University of Medical Sciences
  • Haramaya University
  • University of Southern California
  • Yasuj University of Medical Sciences
  • University of Health and Allied Sciences
  • Karolinska Institutet
  • University of Sharjah
  • Alfaisal University
  • University of Tennessee Health Science Center
  • Wollo University
  • University of New South Wales
  • Cancer Institute NSW
  • Slum and Rural Health Initiative Research Academy
  • University of Ibadan
  • Padjadjaran University
  • University of Management and Technology
  • University of Khartoum
  • University of Basel
  • Yenepoya University
  • Shahid Beheshti University of Medical Sciences
  • Harar Health Science College
  • Rift Valley University
  • Universidad de la Costa
  • Instituto Nacional de Salud
  • University of Tasmania
  • Iran University of Medical Sciences
  • Sultan Qaboos University
  • The University of Lahore
  • Zanjan University of Medical Sciences
  • Public Health Agency of Canada
  • Saveh University of Medical Sciences
  • Arba Minch University
  • Medical University of Łódź
  • Institute of Polish Mother's Health Center
  • Bangladesh University of Health Sciences
  • University of the Gambia
  • Ministry of Health

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with disability and premature death. Up-to-date estimates of the burden of rheumatoid arthritis are required for health-care planning, resource allocation, and prevention. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we provide updated estimates of the prevalence of rheumatoid arthritis and its associated deaths and disability-adjusted life-years (DALYs) by age, sex, year, and location, with forecasted prevalence to 2050. 

Methods: Rheumatoid arthritis prevalence was estimated in 204 countries and territories from 1990 to 2020 using Bayesian meta-regression models and data from population-based studies and medical claims data (98 prevalence and 25 incidence studies). Mortality was estimated from vital registration data with the Cause of Death Ensemble model (CODEm). Years of life lost (YLL) were calculated with use of standard GBD lifetables, and years lived with disability (YLDs) were estimated from prevalence, a meta-analysed distribution of rheumatoid arthritis severity, and disability weights. DALYs were calculated by summing YLLs and YLDs. Smoking was the only risk factor analysed. Rheumatoid arthritis prevalence was forecast to 2050 by logistic regression with Socio-Demographic Index as a predictor, then multiplying by projected population estimates. 

Findings: In 2020, an estimated 17·6 million (95% uncertainty interval 15·8–20·3) people had rheumatoid arthritis worldwide. The age-standardised global prevalence rate was 208·8 cases (186·8–241·1) per 100 000 population, representing a 14·1% (12·7–15·4) increase since 1990. Prevalence was higher in females (age-standardised female-to-male prevalence ratio 2·45 [2·40–2·47]). The age-standardised death rate was 0·47 (0·41–0·54) per 100 000 population (38 300 global deaths [33 500–44 000]), a 23·8% (17·5–29·3) decrease from 1990 to 2020. The 2020 DALY count was 3 060 000 (2 320 000–3 860 000), with an age-standardised DALY rate of 36·4 (27·6–45·9) per 100 000 population. YLDs accounted for 76·4% (68·3–81·0) of DALYs. Smoking risk attribution for rheumatoid arthritis DALYs was 7·1% (3·6–10·3). We forecast that 31·7 million (25·8–39·0) individuals will be living with rheumatoid arthritis worldwide by 2050. 

Interpretation: Rheumatoid arthritis mortality has decreased globally over the past three decades. Global age-standardised prevalence rate and YLDs have increased over the same period, and the number of cases is projected to continue to increase to the year 2050. Improved access to early diagnosis and treatment of rheumatoid arthritis globally is required to reduce the future burden of the disease. Funding: Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health.

Original languageEnglish
Pages (from-to)e594-e610
Number of pages17
JournalLancet Rheumatology
Volume5
Issue number10
DOIs
Publication statusPublished - Oct 2023

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