Li Jun, Li Zhiyong, Hao Chengluo, Chen Xiangrui
The Third People's Hospital of Zigong, Zigong, Sichuan, China.
PLoS One. 2025 Jun 4;20(6):e0325127. doi: 10.1371/journal.pone.0325127. eCollection 2025.
To evaluate the age-standardized incidence (ASIR), prevalence (ASPR), death (ASDR), and disability-adjusted life year (DALY) rates of rheumatoid arthritis (RA) among the working-age population from 1990 to 2021.
The data is sourced from the Global Burden of Disease 2021. Estimated annual percentage change (EAPC) was utilized to assess temporal trends. Decomposition analysis was conducted to identify the driving factors underlying burden changes. The Slope Index of Inequality and the Concentration Index were employed to evaluate cross-country inequalities.
In 2021, there were 11.88 million cases of RA in the working-age population globally and an ASPR of 222.68 per 100,000 population. The ASIR was 14.09 per 100,000 population (95% uncertainty interval [UI]: 8.97 - 20.19), while the ASDR was 0.13 per 100,000 population (95% UI: 0.11-0.15), with an EAPC of -1.59 (95% confidence interval [CI]: -1.73 to -1.45), indicating a sustained decline in RA ASDR. The age-standardized DALYs rate was 34.54 per 100,000 population (95% UI: 23.90 - 48.67), with an EAPC of 0.15 (95% CI: 0.10 to 0.20). Regionally, high Socio-Demographic Index (SDI) regions exhibited the highest ASPR, ASIR, and age-standardized DALYs rates, suggesting a greater overall burden of RA. Interestingly, middle SDI regions showed the highest ASDR, potentially indicating differences in disease management and access to care that impact mortality despite a lower overall burden compared to high SDI regions. Decomposition analysis identified population growth as the primary driver of the increasing RA burden. Cross-national inequality analysis revealed that RA burden remains concentrated in high SDI countries, though overall health inequality has declined.
The substantial global burden and regional disparities of RA in the working-age population necessitate targeted interventions. High SDI regions require strategies focusing on early diagnosis and optimal management to reduce the high burden. Elevated mortality in middle SDI regions demands improved access to effective treatment. These findings underscore the need for SDI-tailored public health approaches to address the specific challenges in each context.
评估1990年至2021年工作年龄人群中类风湿关节炎（RA）的年龄标准化发病率（ASIR）、患病率（ASPR）、死亡率（ASDR）和伤残调整生命年（DALY）率。
数据来源于《2021年全球疾病负担》。采用估计年度百分比变化（EAPC）评估时间趋势。进行分解分析以确定负担变化的驱动因素。采用不平等斜率指数和集中指数评估跨国不平等。
2021年，全球工作年龄人群中RA病例达1188万例，ASPR为每10万人222.68例。ASIR为每10万人14.09例（95%不确定区间[UI]：8.97 - 20.19），而ASDR为每10万人0.13例（95% UI：0.11 - 0.15），EAPC为-1.59（95%置信区间[CI]：-1.73至-1.45），表明RA的ASDR持续下降。年龄标准化DALY率为每10万人34.54例（95% UI：23.90 - 48.67），EAPC为0.15（95% CI：0.10至0.20）。在区域方面，社会人口指数（SDI）高的地区ASPR、ASIR和年龄标准化DALY率最高，表明RA的总体负担更大。有趣的是，SDI中等的地区ASDR最高，这可能表明尽管与SDI高的地区相比总体负担较低，但疾病管理和获得医疗服务方面的差异影响了死亡率。分解分析确定人口增长是RA负担增加的主要驱动因素。跨国不平等分析显示，RA负担仍集中在SDI高的国家，尽管总体健康不平等有所下降。
工作年龄人群中RA的全球负担巨大且存在区域差异，需要有针对性的干预措施。SDI高的地区需要侧重于早期诊断和优化管理的策略，以减轻高负担。SDI中等地区死亡率升高需要改善获得有效治疗服务的机会。这些发现强调了需要针对不同社会人口指数制定公共卫生方法，以应对每种情况下的具体挑战。
