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

Rudan I, Sidhu S, Papana A, Meng SJ, 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 (GHER - J Glob Health (2015)

Bottom Line: 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).Therefore, policy makers and health-care providers need to plan to address a significant disease burden both socially and economically.

View Article: PubMed Central - PubMed

Affiliation: The University of Edinburgh Medical School, Edinburgh, Scotland, UK ; Joint first authorship.

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.

No MeSH data available.


Related in: MedlinePlus

Regional median, minimum and maximum observed value and inter–quartile range for the prevalence of rheumatoid arthritis in low and middle–income countries in six WHO regions of the world.
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Figure 3: Regional median, minimum and maximum observed value and inter–quartile range for the prevalence of rheumatoid arthritis in low and middle–income countries in six WHO regions of the world.

Mentions: When all studies were analysed in one large meta–analysis, irrespective of their heterogeneity, this resulted in an “LMIC” estimate for the prevalence of RA of 0.53% (95% CI: 0.45–0.61%). Analysis of heterogeneity confirmed that the data were highly heterogeneous (I2 = 96%) (Online Supplementary Document(Online Supplementary Document)). We then studied the mean and median prevalence in each of the six WHO regions (Figure 2) and presented box–and–whiskers plot of the results from studies in each region (Figure 3). The Kruskal-Wallis one–way analysis of variance by ranks test showed that the prevalence in at least one of the WHO regions was statistically different from the others (P = 0.029).


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

Rudan I, Sidhu S, Papana A, Meng SJ, 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 (GHER - J Glob Health (2015)

Regional median, minimum and maximum observed value and inter–quartile range for the prevalence of rheumatoid arthritis in low and middle–income countries in six WHO regions of the world.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4416333&req=5

Figure 3: Regional median, minimum and maximum observed value and inter–quartile range for the prevalence of rheumatoid arthritis in low and middle–income countries in six WHO regions of the world.
Mentions: When all studies were analysed in one large meta–analysis, irrespective of their heterogeneity, this resulted in an “LMIC” estimate for the prevalence of RA of 0.53% (95% CI: 0.45–0.61%). Analysis of heterogeneity confirmed that the data were highly heterogeneous (I2 = 96%) (Online Supplementary Document(Online Supplementary Document)). We then studied the mean and median prevalence in each of the six WHO regions (Figure 2) and presented box–and–whiskers plot of the results from studies in each region (Figure 3). The Kruskal-Wallis one–way analysis of variance by ranks test showed that the prevalence in at least one of the WHO regions was statistically different from the others (P = 0.029).

Bottom Line: 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).Therefore, policy makers and health-care providers need to plan to address a significant disease burden both socially and economically.

View Article: PubMed Central - PubMed

Affiliation: The University of Edinburgh Medical School, Edinburgh, Scotland, UK ; Joint first authorship.

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.

No MeSH data available.


Related in: MedlinePlus