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Arthritis Program

Determining the burden of hip/knee osteoarthritis and rheumatoid arthritis using disability-adjusted life-years (DALYs) United States, 1996. Arthritis Program. Charles G. Helmick, MD Catherine Michaud, MD, PhD Margaret Lethbridge-Cejku, PhD Jennifer Hootman, PhD Meghna Majmudar.

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Arthritis Program

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  1. Determining the burden of hip/knee osteoarthritis and rheumatoid arthritis using disability-adjusted life-years (DALYs)United States, 1996 Arthritis Program

  2. Charles G. Helmick, MDCatherine Michaud, MD, PhDMargaret Lethbridge-Cejku, PhDJennifer Hootman, PhDMeghna Majmudar Arthritis Program

  3. Arthritis--A public health problem • 100+ types of arthritis and other rheumatic conditions • high prevalence (43 million in 1997) • 60 million by 2020 • high cost ($65 billion in 1992) • most frequent cause of disability

  4. Leading causes of disability, U.S. adults, 1999 (SIPP) Arthritis/rheumatism Back/spine problem Heart trouble Respiratory problem Deafness/hearing problem Limb/extremity weakness Mental/emotional problem Diabetes Blindness/vision problem Stroke Percent of 41.2 million persons with a disability

  5. The problem--severity and societal burden Given • high prevalence • varying severity of specific conditions What is the absolute and relative societal burden of arthritis using a measure that incorporates severity (DALYs)?

  6. Methods--Outcome • DALYs (disability adjusted life years) • mortality (YLL) • disability (YLD)

  7. Methods • Focus on 2 arthritis conditions • Hip/knee osteoarthritis • Rheumatoid arthritis • Determine absolute DALYs • Determine relative ranking

  8. Methods--Hip/knee osteoarthritis • Incidence of radiographic hip and knee osteoarthritis • % symptomatic • Dutch disability weights for • grade 2 symptomatic = 0.14 • grade 3-4 symptomatic = 0.42 • age/sex specific weights

  9. Methods--Rheumatoid arthritis • Incidence of rheumatoid arthritis • GBD disability weight = 0.186 • untreated = 0.233 • treated = 0.174 • no age/sex specific weights

  10. Results--hip/knee osteoarthritis US DALYsRank % total Overall 941,321 10th 2.83 Women 507,098 7th 3.31 Men 434,223 13th 2.42

  11. Results--rheumatoid arthritis US DALYs Rank Overall 201,676 >20th Women 140,929 >20th Men 60,747 >20th

  12. Top 10 causes of DALYs, US, 1996 1. ischemic heart disease 9.5 % 2. cerebrovascular disease 4.5 3. unipolar major depression 4.3 4. road traffic accidents 4.2 5. lung/trachea/bronchial cancer 4.1 6. chronic obstructive pulmonary disease 3.8 7. alcohol use 3.5 8. HIV/AIDS 2.9 9. diabetes 2.9 10. hip/knee osteoarthritis 2.8

  13. #11-20 causes of DALYs, US, 1996 11. dementias 2.7% 12. congenital abnormalities 2.3 13. homicide and violence 2.2 14. asthma 2.0 15. suicide 2.0 16. drug use 1.8 17. breast cancer 1.6 18. perinatal conditions 1.5 19. colon/rectum cancer 1.5 20. cirrhosis of the liver 1.2

  14. Discussion • Strengths • standard, summary measure (DALY) • first US DALY estimates for arthritis • Limitations • many types of arthritis excluded • limited data on prevalence, incidence, distribution, weights

  15. Conclusions • Incorporating severity into a disability measure • hip/knee osteoarthritis alone makes the top ten DALY list • adding 100+ other types of arthritis would raise the ranking higher

  16. Conclusion • arthritis remains a large absolute and relative societal burden • arthritis interventions warrant greater attention as a means of reducing disability

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