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The Rising Burden of Rheumatoid Arthritis Surpasses Rheumatology Supply in Ontario

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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.

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.

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Author information

Authors and Affiliations

  1. University of Toronto, Toronto, ON, Canada

    Jessica Widdifield PhD, J. Michael Paterson MSc, Karen Tu MD, MSc, Noah Ivers MD, Debra Butt MD, MSc, R. Liisa Jaakkimainen MD, MSc, George Tomlinson PhD & Claire Bombardier MD, FRCPC

  2. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Jessica Widdifield PhD, J. Michael Paterson MSc, Karen Tu MD, MSc, Noah Ivers MD & R. Liisa Jaakkimainen MD, MSc

  3. McMaster University, Hamilton, ON, Canada

    J. Michael Paterson MSc

  4. McGill University, Montreal, QC, Canada

    Sasha Bernatsky MD, FRCPC, PhD

  5. Southlake Regional Health Centre, Newmarket, ON, Canada

    J. Carter Thorne MD, FRCPC

  6. William Osler Health Center, Brampton, ON, Canada

    Vandana Ahluwalia MD, FRCPC

  7. Women’s College Hospital, Toronto, ON, Canada

    Noah Ivers MD

  8. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    R. Liisa Jaakkimainen MD, MSc

Authors
  1. Jessica Widdifield PhD
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  2. J. Michael Paterson MSc
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  3. Sasha Bernatsky MD, FRCPC, PhD
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  4. Karen Tu MD, MSc
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  5. J. Carter Thorne MD, FRCPC
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  6. Vandana Ahluwalia MD, FRCPC
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  7. Noah Ivers MD
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  8. Debra Butt MD, MSc
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  9. R. Liisa Jaakkimainen MD, MSc
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  10. George Tomlinson PhD
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  11. Claire Bombardier MD, FRCPC
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Corresponding author

Correspondence to Jessica Widdifield PhD.

Additional information

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.

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Widdifield, J., Paterson, J.M., Bernatsky, S. et al. The Rising Burden of Rheumatoid Arthritis Surpasses Rheumatology Supply in Ontario. Can J Public Health 104, e450–e455 (2013). https://doi.org/10.17269/cjph.104.4115

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  • DOI: https://doi.org/10.17269/cjph.104.4115

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