Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis

Igor Rudan; Simrita Sidhu; Angeliki Papana; Shi-Jiao Meng; Yu Xin-Wei; Wei Wang; Ruth M Campbell-Page; Alessandro Rhyll Demaio; Harish Nair; Devi Sridhar; Evropi Theodoratou; Ben Dowman; Davies Adeloye; Azeem Majeed; Josip Car; Harry Campbell; Wei Wang; Kit Yee Chan; Global Health Epidemiology Reference Group (GHERG)

doi:10.7189/jogh.05.010409

Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis

Igor Rudan, Simrita Sidhu, Angeliki Papana, Shi-Jiao Meng, Yu Xin-Wei, Wei Wang, Ruth M Campbell-Page, Alessandro Rhyll Demaio, Harish Nair, Devi Sridhar, Evropi Theodoratou, Ben Dowman, Davies Adeloye, Azeem Majeed, Josip Car, Harry Campbell, Wei Wang, Kit Yee Chan, Global Health Epidemiology Reference Group (GHERG)

Global Health Section

Abstract

Background Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC). Methods The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. Results Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010. Conclusion Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health- care providers need to plan to address a significant disease burden both socially and economically.

Original language	English
Article number	010409
Journal	Journal of Global Health
Volume	5
Issue number	1
Pages (from-to)	1-10
Number of pages	10
ISSN	2047-2978
DOIs	https://doi.org/10.7189/jogh.05.010409
Publication status	Published - Jun 2015

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Rudan, I., Sidhu, S., Papana, A., Meng, S-J., Xin-Wei, Y., Wang, W., Campbell-Page, R. M., Demaio, A. R., Nair, H., Sridhar, D., Theodoratou, E., Dowman, B., Adeloye, D., Majeed, A., Car, J., Campbell, H., Wang, W., Chan, K. Y., & Global Health Epidemiology Reference Group (GHERG) (2015). Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis. Journal of Global Health, 5(1), 1-10. [010409]. https://doi.org/10.7189/jogh.05.010409

Rudan, I, Sidhu, S, Papana, A, Meng, S-J, Xin-Wei, Y, Wang, W, Campbell-Page, RM, Demaio, AR, Nair, H, Sridhar, D, Theodoratou, E, Dowman, B, Adeloye, D, Majeed, A, Car, J, Campbell, H, Wang, W, Chan, KY & Global Health Epidemiology Reference Group (GHERG) 2015, 'Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis', Journal of Global Health, vol. 5, no. 1, 010409, pp. 1-10. https://doi.org/10.7189/jogh.05.010409

@article{10e023417d0f4cd7bca858de8f3406f0,

title = "Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis",

abstract = "Background Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC). Methods The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. Results Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010. Conclusion Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health- care providers need to plan to address a significant disease burden both socially and economically.",

author = "Igor Rudan and Simrita Sidhu and Angeliki Papana and Shi-Jiao Meng and Yu Xin-Wei and Wei Wang and Campbell-Page, {Ruth M} and Demaio, {Alessandro Rhyll} and Harish Nair and Devi Sridhar and Evropi Theodoratou and Ben Dowman and Davies Adeloye and Azeem Majeed and Josip Car and Harry Campbell and Wei Wang and Chan, {Kit Yee} and {Global Health Epidemiology Reference Group (GHERG)}",

year = "2015",

month = jun,

doi = "10.7189/jogh.05.010409",

language = "English",

volume = "5",

pages = "1--10",

journal = "Global journal of health science",

issn = "1916-9736",

publisher = "Canadian Center of Science and Education",

number = "1",

}

TY - JOUR

T1 - Prevalence of rheumatoid arthritis in low- and middle-income countries

T2 - A systematic review and analysis

AU - Rudan, Igor

AU - Sidhu, Simrita

AU - Papana, Angeliki

AU - Meng, Shi-Jiao

AU - Xin-Wei, Yu

AU - Wang, Wei

AU - Campbell-Page, Ruth M

AU - Demaio, Alessandro Rhyll

AU - Nair, Harish

AU - Sridhar, Devi

AU - Theodoratou, Evropi

AU - Dowman, Ben

AU - Adeloye, Davies

AU - Majeed, Azeem

AU - Car, Josip

AU - Campbell, Harry

AU - Wang, Wei

AU - Chan, Kit Yee

AU - Global Health Epidemiology Reference Group (GHERG)

PY - 2015/6

Y1 - 2015/6

N2 - Background Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC). Methods The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. Results Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010. Conclusion Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health- care providers need to plan to address a significant disease burden both socially and economically.

AB - Background Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC). Methods The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. Results Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010. Conclusion Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health- care providers need to plan to address a significant disease burden both socially and economically.

UR - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416333/

U2 - 10.7189/jogh.05.010409

DO - 10.7189/jogh.05.010409

M3 - Journal article

C2 - 25969732

SN - 1916-9736

VL - 5

SP - 1

EP - 10

JO - Global journal of health science

JF - Global journal of health science

IS - 1

M1 - 010409

ER -

Prevalence of rheumatoid arthritis in low- and middle-income countries: A systematic review and analysis

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