Clinical Epidemiology Unit T2, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Ann Rheum Dis. 2011 Apr;70(4):624-9. doi: 10.1136/ard.2010.133371. Epub 2010 Dec 13.
To provide Swedish nationwide data on the prevalence of rheumatoid arthritis (RA), including variations by age, sex, geography, demography and education level, and assess antirheumatic treatment penetration.
Patients ≥16 years assigned an RA diagnosis were identified from inpatient (n=96 560; 1964-2007) and specialist outpatient care (n=56 336; 2001-2007) in the Swedish National Patient Register, and the Swedish Rheumatology Quality Register (n=21 242; 1995-2007). Data on prescriptions, demography, vital status and educational level were retrieved from national registers.
A total of 58 102 individuals (mean age 66 years; 73% women) assigned an RA diagnosis were alive in Sweden in 2008, corresponding to a cumulative prevalence of 0.77% (women 1.11%, men 0.43%). The 2001-2007 period prevalence was 0.70%. Restriction to patients with ≥2 visits or diagnosis from a rheumatologist/internist reduced the overall cumulative prevalence to 0.68%. Whereas urban/rural differences (crude 0.65-1.00%) were explained by age differences, the age/sex-adjusted prevalence remained higher in patients with ≤9 years education (0.86%) than for those with 10-12 years (0.82%) and >12 years (0.65%). Treatment exposures (76% any disease-modifying antirheumatic drugs (DMARDs) or steroids, 64% any DMARD, 15% biological agents) varied with age; use of biological agents decreased from 22% in 16-59 years olds to 3% in ≥80 years olds. Any DMARD use correspondingly decreased from 71% to 43%. Applying age cut-off points from previous northern European and North American prevalence studies reduced or eliminated between-study differences.
This nationwide approach yielded a prevalence of RA similar to previous regional assessments. While displaying only modest geographical variation and no urban/rural gradient, prevalence was associated with educational level. Although most patients received antirheumatic drugs, age was a strong treatment determinant.
提供瑞典全国范围内类风湿关节炎（RA）的流行率数据，包括按年龄、性别、地理位置、人口统计学和教育水平的变化，并评估抗风湿治疗的普及情况。
从瑞典全国住院患者登记处（n=96560；1964-2007 年）和专科门诊患者登记处（n=56336；2001-2007 年）中确定≥16 岁的 RA 患者，并从瑞典风湿病质量登记处（n=21242；1995-2007 年）获取处方、人口统计学、生存状态和教育水平数据。
2008 年瑞典共有 58102 名（平均年龄 66 岁；73%为女性）存活的 RA 患者，累积患病率为 0.77%（女性 1.11%，男性 0.43%）。2001-2007 年期间的患病率为 0.70%。将至少 2 次就诊或由风湿病医生/内科医生诊断的患者限制在内，可将总体累积患病率降至 0.68%。虽然城乡差异（粗率 0.65-1.00%）由年龄差异解释，但受教育程度≤9 年的患者（0.86%）的患病率高于受教育程度为 10-12 年（0.82%）和>12 年（0.65%）的患者。治疗暴露率（76%使用任何疾病修饰抗风湿药物（DMARDs）或类固醇，64%使用任何 DMARD，15%使用生物制剂）随年龄变化而变化；生物制剂的使用率从 16-59 岁的 22%降至≥80 岁的 3%。相应地，任何 DMARD 的使用率从 71%降至 43%。应用以前北欧和北美患病率研究中的年龄切点会减少或消除研究间的差异。
这种全国性方法得出的 RA 患病率与以前的区域性评估相似。虽然仅显示出适度的地域差异，且无城乡梯度，但患病率与教育程度相关。尽管大多数患者接受了抗风湿药物治疗，但年龄是一个重要的治疗决定因素。
