Chapter 1: Life with arthritis in Canada: a personal and public health challenge – What is arthritis and how common is it?

I was quite concerned and depressed about the diagnosis as I had an aunt who at that time was already quite "deformed" by her rheumatoid arthritis. I was only about 27 at the time, with two young children and very active physically. I did not want to face this change in my lifestyle.

— Person living with rheumatoid arthritis

I was only six and a half years old, just remember being scared to be in the hospital. I was in there for a month while they took daily blood and skin tests. My disease went into remission at age 11, so I enjoyed a normal life, enjoyed some school sports and got two jobs after school, took karate, played paintball. But at age 24, the disease came roaring back, affecting multiple joints—some of which were not touched before—causing complete and permanent disability. I have not worked since. Became a shut in. Medicine in those days was not very effective.

— Person living with rheumatoid arthritis

Introduction

This chapter addresses two key questions: "What is arthritis?" and "How common is it?" The first section describes arthritis in general and its different types. The second section presents the prevalence of arthritis in the Canadian population according to personal characteristics, place of residence and projects the prevalence of arthritis into the future.

What is arthritis?

Put simply, arthritis means "joint inflammation" and encompasses more than 100 rheumatic diseases and conditions that affect the joints, the tissues that surround the joint and other connective tissue. The most familiar types of arthritis are osteoarthritis (OA), rheumatoid arthritis (RA), systemic lupus erythematosus, childhood or juvenile idiopathic arthritis (JIA), and gout (Table 1-1). For further information about the different types of arthritis see the Glossary.

Table 1-1 Major types of arthritis
Osteoarthritis
(OA)
Rheumatoid Arthritis (RA) Ankylosing Spondylitis (AS) and other spondyloarthropathies Connective tissue disorders Table 1 - Footnote * Juvenile Idiopathic Arthritis (JIA) Gout
*Also known as Systemic Autoimmune Rheumatic Diseases ( SARDS) in Canada.
Background OA results from deterioration of cartilage and thickening of the bones underneath, in one or more joints. This leads to joint damage, pain and stiffness. Typically affects hands, feet, knees, spine and hips. RA is caused by the body's immune system attacking the body's joints (primarily hands, wrists and feet). This leads to pain, inflammation and joint damage. RA may also involve other organ systems such as eyes, heart and lungs. Inflammatory arthritis of the spine. Causes pain and stiffness in the back and possibly a bent posture. Usually characterized by acute painful episodes and remissions. Disease severity varies widely among individuals.

Other spondyloarthropathies include psoriatic arthritis and Reiter's disease.
Connective tissue disorder causing skin rashes, joint and muscle swelling, and pain. May also affect organs. Fluctuates over time, with flare-ups and periods of remission.

Connective tissue disorders include systemic lupus erythematosus, scleroderma, polymyositis, dermatomyosi- tis, and Sjögren's syndrome.
JIA is a rare chronic condition of children and adolescents. Although rarely fatal, the condition is long-term and associated with serious physical disability. Gout is caused by too much uric acid in the body. Most often affects the big toe but can also affect the ankle, knee, foot, hand, wrist or elbow.

Gout can be episodic, with long periods of remission followed by flare-ups for days to weeks, or it can become chronic.
Prevalence Affects more than 10% Canadian adults. Affects approximately 1% of Canadian adults (at least twice as many women as men). Affects approximately 1% of Canadian adults (three times more men than women). Affects approximately 0.05% of Canadian adults (up to ten times more women than men). Affects approximately 5 to 10 per 10,000 children under the age of 16 years. Affects up to 3% of Canadian adults (four times more men than women).
Possible risk factors Age, heredity, obesity, previous joint injury. Hormones, heredity, ethnicity. Heredity and possibly, gastrointestinal or genitourinary infections and psoriasis (in the case of psoriatic arthritis). Heredity, hormones and possibly a variety of environmental factors. Onset may coincidentally follow a routine infection or injury, but such common events do not cause JIA. The immune system may be responsible for the inflammation. Heredity, certain medications (e.g. diuretics), alcohol and certain foods (high intake of purine rich foods such as red meat and seafood).
Possible management strategies Treatments can decrease pain and improve joint mobility, and include:
  • Medication (e.g. analgesics, anti-inflammatory drugs)
  • Exercise
  • Physiotherapy/ Occupational therapy
  • Weight loss/Healthy weight
  • Participation in self- management education programs
In severe cases, the entire joint — particularly the hip or knee — may be replaced through surgery.
Early, aggressive treatment by a rheumatologist can prevent joint damage.
  • Medication (e.g. non- steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) and biologic response modifiers)
  • Exercise
  • Physiotherapy / 0ccupa- tional therapy
  • Healthy weight
  • Participation in self- management education programs
Medications similar to those used for other types of arthritis are often prescribed to treat AS.
  • Exercise
  • Physiotherapy / 0ccupa- tional therapy
  • Healthy weight
  • Participation in self- management education programs
If damage is severe, surgery may be considered
Treatment goal is to control symptoms, reduce the number of flare-ups and prevent damage.
  • Medication (e.g. analgesics, anti-inflammatory drugs, cortisone and disease-modifying anti-rheumatic drugs (DMARDs))
  • Exercise
  • Physiotherapy/ Occupational therapy
  • Healthy weight
  • Participation in self- management education programs
  • Balanced diet and avoiding excessive alcohol consumption
  • Medication (e.g. non-steroidal anti-inflammatory drugs (NSAIDs) are often used to treat JIA to help reduce pain and swelling and decrease stiffness)
  • Exercise
  • Physiotherapy/ Occupational therapy: to minimize long-term damage to joints and muscles and to preserve function
  • Healthy weight
  • Participation in self- management education programs
  • Medication (e.g. non- steroidal anti-inflammatory drugs (NSAIDs) and allopurinol can be used on a long-term basis to reduce uric acid levels and prevent future attacks.
  • Exercise
  • Physiotherapy/Occupa- tional therapy
  • Healthy weight
  • Participation in self- management education programs

Text Equivalent - Table 1-1

Table 1-1

Information from the literature on the major types of arthritis including prevalence, possible risk factors and management strategies is summarized in Table 1-1.  The most familiar types of arthritis are osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus, childhood or juvenile idiopathic arthritis (JIA) and gout.


 

Most types of arthritis are characterized by pain, aching, stiffness and swelling in and around joints or elsewhere in the musculoskeletal system.Footnote 1 They can affect the structure and functioning of the joints, leading to increased pain, disability and difficulty in performing everyday tasks and activities.Footnote 1 Footnote 2 Footnote 3 Footnote 4 Footnote 5

Arthritis affects people of all ages. Although it is most prevalent among seniors, arthritis also affects babies, toddlers and people in the prime of their working lives, and can cause lifelong, permanent disability.

At the present time there is no known cure for arthritis, but appropriate treatment and management can prevent disability, maintain function and reduce pain.Footnote 1 Footnote 3 Footnote 4 Footnote 5 While treatments vary according to the type of arthritis, general management and rehabilitation interventions are similar for all types. It includes pain management, self-management education, maintenance of healthy weight, medication and minimization of the impact of arthritis via rehabilitation interventions, such as adapted exercises and the use of assistive devices.

How common is arthritis?

Arthritis is one of the most common chronic health conditions in Canada and a major cause of morbidity, disability and health care utilization.Footnote 2 Footnote 6 Footnote 7

Data from the Canadian Community Health Survey (CCHS) 2007-2008 were used for this chapter.Footnote 1a * The CCHS asked respondents about the presence of chronic conditions with the question "Do you have any of the following long-term conditions that have been diagnosed by a health professional?" "Arthritis, excluding fibromyalgia" was one of the options from which respondents could choose. The CCHS defined a long-term condition as lasting or expected to last six months or longer. Data for people aged 15 years and over were included in this chapter.

Between 2005 and 2007-2008, the wording of the question on arthritis was changed. In 2001, 2003 and 2005, the question included the term "rheumatism", whereas in 2007-2008, this term was removed from the question. Consequently, the estimated prevalence of arthritis cannot be directly compared over time and the estimates presented in this chapter may appear lower than in the previous years. The change in the wording must be taken into account when interpreting and comparing current estimates to those of previous years.

"When I was first diagnosed, I thought, That's it. I'm 34 and life is finished."

— Person living with rheumatoid arthritis

Prevalence by age and sex

In 2007-2008, arthritis as a long-term health condition affected more than 4.2 million Canadians aged 15 years and older — or 16% of this population. Arthritis was the second and third most common chronic condition reported by women and men, respectively (Figure 1-1).

Figure 1-1: Self-reported prevalence of specific chronic conditions by sex, household population aged 15 years and older, Canada, 2007-2008

Figure 1-1 Self-reported prevalence of specific chronic conditions by sex, household

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-1
Figure 1-1: Self-reported prevalence of specific chronic conditions by sex, household population aged 15 years and older, Canada, 2007-2008
Chronic Conditions Men (%) Women (%)
Back Pain 19.8 22.2
High Blood Pressure 16.4 17.6
Arthritis 12.6 19.2
Migraine 6.6 14.9
Mood or anxiety disorder 7.2 12.7
Asthma 6.8 9.3
Diabetes 6.8 5.6
Heart Disease 5.6 4.5
Bowel disorder/Crohn's disease or colitis 2.9 6.1
Urinary Incontinence 2.1 4.6
Ulcers 3.0 3.0
Cancer 1.8 2.1
Stroke 1.2 1.1
Alzheimer's disease or dementia 0.4 0.4



The prevalence of arthritis increased with increasing age (Figure 1-2). In all age groups, prevalence of arthritis was higher among women than men. Overall, nearly two-thirds (64%) of those affected with arthritis were women, among whom the prevalence was 19%. Prevalence among men was 13%.

Several factors, such as longer life expectancy, hormones and lower socio-economic status, may explain the higher prevalence of arthritis among women.Footnote 8 Footnote 9

Figure 1-2: Self-reported prevalence and number of individuals with arthritis by age and sex, household population aged 15 years and older, Canada, 2007-2008

Figure 1-2 Self-reported prevalence and number of individuals with arthritis

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada.
E – Interpret with caution.

Text Equivalent - Figure 1-2
Figure 1-2: Self-reported prevalence and number of individuals with arthritis by age and sex, household population aged 15 years and older, Canada, 2007-2008
Age group Men (%) Women (%) Number of men and women
15-19 0.68 E 0.81 E 15476
20-24 1.71 E 1.95 E 40301
25-29 2.39 3.42 65772
30-34 2.71 4.75 81570
35-39 5.62 6.77 141762
40-44 8.38 10.07 235798
45-49 10.54 15.59 341549
50-54 16.82 21.61 471367
55-59 19.48 30.06 537992
60-64 25.41 37.47 534737
65-69 28.59 43.71 478442
70-74 33.21 47.00 431613
75-79 35.35 54.69 401337
80-84 41.62 55.32 287528
85+ 45.19 60.99 194450



Although arthritis is perceived as a disease of the elderly, nearly 3 in 5 people (58%) who reported having arthritis in 2007-2008 were younger than 65 years of age (Figure 1-3).

Figure 1-3: Proportion of total number of individuals with arthritis by age group, household population aged 15 years and older, Canada, 2007-2008

Figure 1-3: Proportion of total number of individuals with arthritis, by age group, household population aged 15 years and older, Canada, 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-3
Fig 1-3: Proportion of total number of individuals with arthritis by age group, household population aged 15 years and older, Canada, 2007-2008
Age group Proportion of men and women (%) Number of men and women
15-44 14 580679
45-64 44 1885645
65-74 21 910055
75 + 21 883315



Geographic variations in prevalence

This section presents crude and age-standardized prevalence of arthritis by province/territory. It also shows age- standardized prevalence of arthritis by urban/rural areas and health regions. Crude prevalence is defined as the number of events (in this case, the number of people with arthritis) over a specified period of time, divided by the total population. Age – standardization serves to diminish the effect of differences in the age compositions of the various geographic areas and permit direct comparison with the overall Canadian prevalence.

Provinces and Territories

The crude prevalence of arthritis varied considerably across Canada in 2007-2008 (Figure 1-4 and Table 1-2). The highest percentage of individuals who reported having arthritis was found in Nova Scotia (23%), followed by Newfoundland and Labrador (21%), and New Brunswick and Prince Edward Island (20% and 19% respectively). The province of Quebec (12%) and the Territories (Yukon, Northwest Territories and Nunavut) (11%) had the lowest percentage of individuals who reported having arthritis.

Provinces and territories have different age compositions so age-standardized prevalence estimates were calculated to identify if the differences remained after adjusting for these age differences. Newfoundland and Labrador and Nova Scotia were significantly higher (1.1-1.3 times) than the national prevalence, whereas Quebec and British Columbia were significantly lower (0.6-0.9 times) (Table 1-2). This pattern has been consistently reported over time.Footnote 2 Footnote 10 Differences in obesity rates and demographic and socio-economic factors (e.g. variations in ethnic composition, rural/urban, education, income levels, etc) might explain the provincial variations in the prevalence of self-reported arthritis.Footnote 10

Figure 1-4: Crude self-reported prevalence of arthritis, by province/territory, household population aged 15 years and older, Canada, 2007-2008 (see Table 1-2 in the report for data)

Figure 1-4 Crude self-reported prevalence of arthritis, by province/territory, Standardized prevalence significantly lower than national prevalence. Standardized prevalence significantly higher than national prevalence.

Source: Public Health Agency of Canada, using Canadian Community Health Survey, 2007-2008, Statistics Canada and 1991 Census population for age-standardization.

Text Equivalent - Figure 1-4
Table 1-2 Number of individuals, crude and age-standardized prevalence of self-reported arthritis, by province/territory, household population aged 15 years and older, Canada, 2007-2008 4,259,694 16.0 15.3

Table 1-2 Number of individuals, crude and age-standardized prevalence of self-reported arthritis, by province/territory, household population aged 15 years and older, Canada, 2007-2008
Province Number Crude rate (%) Age – standardized rate per 100 population
Source: Public Health Agency of Canada, using Canadian Community Health Survey, 2007-2008, Statistics Canada and 1991 Census population for age-standardization.
British Columbia 560,925 15.7 13.5
Alberta 411,892 14.9 14.8
Saskatchewan 140,658 18.6 15.8
Manitoba 156,349 17.4 15.2
Ontario 1,825,011 17.5 15.7
Quebec 744,037 11.8 9.9
New Brunswick 124,712 20.3 17.0
Nova Scotia 177,515 23.4 19.6
Prince Edward Island 21,592 19.0 16.3
Newfoundland and Labrador 88,929 21.0 17.4
Territories 8,074 11.3 14.2
Canada 4,259,694 16.0 15.3

Text Equivalent - Table 1-2

Table 1-2

The number of individuals, crude and age-standardized prevalence of self-reported arthritis, by province/territory, among individuals aged 15 years and older, in 2007-2008 are presented in Table 1-2.

The crude prevalence of arthritis varied considerably across Canada in 2007-2008.  The highest percentage of individuals who reported having arthritis was found in Nova Scotia (23%), followed by Newfoundland and Labrador (21%), and New Brunswick and Prince Edward Island (20% and 19% respectively).  The province of Quebec (12%) and the Territories (Yukon, Northwest Territories and Nunavut) (11%) had the lowest percentage of individuals who reported having arthritis.

Provinces and territories have different age compositions so age-standardized prevalence estimates were calculated to identify if the differences remained after adjusting for these age differences.  Newfoundland and Labrador and Nova Scotia were significantly higher (1.1-1.3 times) than the national prevalence whereas, Quebec and British Columbia were significantly lower (0.6-0.9 times).

Source: Public Health Agency of Canada, using Canadian Community Health Survey, 2007-2008, Statistics Canada and 1991 Census population for age-standardization.


Urban and rural areas

Both men and women residing in rural areas reported statistically higher rates of arthritis compared to those residing in urban areas (Figure 1-5). In both rural and urban settings, prevalence of arthritis was higher among women than men. The highest prevalence of arthritis was among women living in rural settings (18%). Higher obesity rates and higher (paid or unpaid) work-related injury rates are consistent with the higher prevalence of arthritis among rural Canadians.Footnote 11 Footnote 12 Footnote 13 Footnote 14 Agricultural occupations, such as farming, have been found to be associated with higher prevalence of musculoskeletal conditions, particularly osteoarthritis of the hip and knee.Footnote 12 Footnote 13 Footnote 14

Figure 1-5: Age-standardized self-reported prevalence of arthritis, by rural and urban place of residence and sex, household population aged 15 years and older, Canada 2007-2008

Figure 1-5 Age-standardized self-reported prevalence of arthritis, by rural and urban place of residence and sex, household population aged 15 years and older Canada, 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-5
Figure 1-5: Age-standardized self-reported prevalence of arthritis, by rural and urban place of residence and sex, household population aged 15 years and older, Canada 2007-2008
Place of residence Men (%) Women (%)
Urban 10.9 16.1
Rural 14.0 17.8



Health regions

The age-standardized prevalence of arthritis varied considerably across Canadian health regions (Figure 1-6). The highest prevalence of arthritis in the country was reported in Ontario's Hastings and Prince Edward counties (27%) and the lowest was reported in Richmond, British Columbia (7%).Footnote 1c * Regional variations in socio-economic status, body mass index and ethnic composition could contribute to the observed variations.Footnote 1

Figure 1-6: Age standardized self-reported prevalence of arthritis, by health regions, household population aged 15 years and older, Canada 2007-2008

Figure 1-6: Age-standardized self-reported prevalence of arthritis (in quartiles), Prevalence of Arthritis 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-6
Figure 1-6: Age standardized self-reported prevalence of arthritis, by health regions, household population aged 15 years and older, Canada 2007-2008
Health Region Prevalence (%)
ESTRIE 7.7
LAVAL 8.6
MAUR./CTR-QUÉBEC 9.2
LANAUDIÈRE 9.4
MONTÉRÉGIE 9.4
RICHMOND 9.5
MONTRÉAL 9.8
NORD-DU-QUÉBEC 9.8
CAPITALE-NAT.L 9.9
LAURENTIDES 10.2
ABITIBI-TÉMISC. 10.3
CÔTE-NORD 10.5
GASP.-ÎLES-MADE. 10.5
CHAU.-APPALACHES 10.8
SAGUENAY - LAC ST-JEAN 10.8
OUTAOUAIS 11.1
N. SHORE/C. GARI 11.5
VANCOUVER 11.8
KOOTENAY-BOUND. 11.9
FRASER NORTH 12.2
BAS-ST-LAURENT 12.3
FRASER SOUTH 12.4
CITY OF TORONTO 12.6
CALGARY 12.8
WATERLOO 12.9
CITY OTTAWA 12.9
YORK REGIONAL 13.2
S. VANCOUVER ISL 13.7
PEEL REGIONAL 13.8
YUKON 13.9
NWT 14.1
BRANDON 14.1
THOMPSON/CARIBOO 14.2
QU APPELLE 14.2
FRASER EAST 14.4
WINNIPEG 14.5
REGION 6 14.5
NORTH. INTERIOR 14.5
WELL.-DUF.-GUELPH 14.6
DAVID THOMPSON 14.7
LABRADOR-GRENFEL 14.7
MIDDLESEX-LONDON 14.9
CENTRAL 14.9
EAST CENTRAL 14.9
HURON COUNTY 15.1
PALLISER 15.1
SUN COUNTRY 15.2
CHINOOK RHA 15.3
PERTH 15.3
OXFORD COUNTY 15.3
REGION 1 15.3
N. VANCOUVER ISL 15.3
CAPITAL HEALTH 15.5
REGION 7 15.5
C. VANCOUVER ISL 15.5
SASKATOON 15.6
HEARTLAND 15.7
QUEENS COUNTY 15.7
SOUTH EASTMAN 15.7
REGION 4 15.8
FIVE HILLS 16.1
HALTON REG. 16.1
MAMAW/KEEW/ATHAB 16.2
DURHAM REGION 16.3
NORTH EASTMAN 16.3
PRINCE ALBERT 16.4
EASTERN REGIONAL 16.5
NUNAVUT 16.5
KINGS COUNTY 16.6
SIMCOE MUSKOKA 16.7
PRINCE COUNTY 16.7
CYPRESS 16.9
GREY BRUCE 16.9
NORTHEAST 16.9
REGION 5 16.9
PEACE COUNTY 17.0
BURNTW/CHURCHILL 17.1
CITY HAMILTON 17.1
ASSINIBOINE 17.2
PRAIRIE NORTH 17.4
TIMISKAMING 17.4
WESTERN REGIONAL 17.4
NORTHERN LIGHTS 17.4
NORTHWEST 17.6
NIAGARA REG. 17.8
ZONE 6 (DHA 9) 17.9
INTERLAKE 18.0
THUNDER BAY 18.1
OKANAGAN 18.2
EAST KOOTENAY 18.4
REGION 2 18.4
RENFREW 18.5
HALDIMAND-NORF. 18.6
SUNRISE 18.6
REGION 3 18.7
EAST. ONTARIO 18.7
BRANT COUNTY 18.7
PARKLAND 19.0
KELSEY TRAIL 19.0
DISTR. ALGOMA 19.1
NORTHWESTERN 19.1
NORMAN 19.2
ZONE 4 (DHA 6&7) 19.3
LAMBTON HU 19.3
WINDSOR-ESSEX 19.5
PETERBOROUGH 19.6
CHATHAM-KENT 19.7
KING/FRO/LEN/ADD 20.1
ZONE 2 (DHA 3) 20.2
ZONE 1 (DHA 1&2) 20.3
CENTRAL REGIONAL 20.4
ELGIN-ST THOMAS 20.5
ZONE 5 (DHA 8) 20.7
SUDBURY 21.0
ASPEN 21.1
N. BAY PARRY SND 21.4
HALIBURTON, KAW, PINE RIDGE 21.9
LEEDS/GREN/LAN 21.9
PORCUPINE 22.4
ZONE 3 (DHA 4&5) 22.8
HASTINGS/P.E CNT 23.2
EASTERN REGIONAL 16.5
CENTRAL REGIONAL 20.4
WESTERN REGIONAL 17.4
LABRADOR-GRENFEL 14.7
KINGS COUNTY 16.6
QUEENS COUNTY 15.7
PRINCE COUNTY 16.7
ZONE 1 (DHA 1&2) 20.3
ZONE 2 (DHA 3) 20.2
ZONE 3 (DHA 4&5) 22.8
ZONE 4 (DHA 6&7) 19.3
ZONE 5 (DHA 8) 20.7
ZONE 6 (DHA 9) 17.9
REGION 1 15.3
REGION 2 18.4
REGION 3 18.7
REGION 4 15.8
REGION 5 16.9
REGION 6 14.5
REGION 7 15.5
BAS-ST-LAURENT 12.3
SAGUENAY - LAC ST-JEAN 10.8
CAPITALE-NAT.L 9.9
MAUR./CTR-QUÉBEC 9.2
ESTRIE 7.7
MONTRÉAL 9.8
OUTAOUAIS 11.1
ABITIBI-TÉMISC. 10.3
CÔTE-NORD 10.5
NORD-DU-QUÉBEC 9.8
GASP.-ÎLES-MADE. 10.5
CHAU.-APPALACHES 10.8
LAVAL 8.6
LANAUDIÈRE 9.4
LAURENTIDES 10.2
MONTÉRÉGIE 9.4
DISTR. ALGOMA 19.1
BRANT COUNTY 18.7
DURHAM REGION 16.3
ELGIN-ST THOMAS 20.5
GREY BRUCE 16.9
HALDIMAND-NORF. 18.6
HALIBURTON, KAW, PINE RIDGE 21.9
HALTON REG. 16.1
CITY HAMILTON 17.1
HASTINGS/P.E CNT 23.2
HURON COUNTY 15.1
CHATHAM-KENT 19.7
KING/FRO/LEN/ADD 20.1
LAMBTON HU 19.3
LEEDS/GREN/LAN 21.9
MIDDLESEX-LONDON 14.9
NIAGARA REG. 17.8
N. BAY PARRY SND 21.4
NORTHWESTERN 19.1
CITY OTTAWA 12.9
OXFORD COUNTY 15.3
PEEL REGIONAL 13.8
PERTH 15.3
PETERBOROUGH 19.6
PORCUPINE 22.4
RENFREW 18.5
EAST. ONTARIO 18.7
SIMCOE MUSKOKA 16.7
SUDBURY 21.0
THUNDER BAY 18.1
TIMISKAMING 17.4
WATERLOO 12.9
WELL.-DUF.-GUELPH 14.6
WINDSOR-ESSEX 19.5
YORK REGIONAL 13.2
CITY OF TORONTO 12.6
WINNIPEG 14.5
BRANDON 14.1
NORTH EASTMAN 16.3
SOUTH EASTMAN 15.7
INTERLAKE 18.0
CENTRAL 14.9
ASSINIBOINE 17.2
PARKLAND 19.0
NORMAN 19.2
BURNTW/CHURCHILL 17.1
SUN COUNTRY 15.2
FIVE HILLS 16.1
CYPRESS 16.9
QU APPELLE 14.2
SUNRISE 18.6
SASKATOON 15.6
HEARTLAND 15.7
KELSEY TRAIL 19.0
PRINCE ALBERT 16.4
PRAIRIE NORTH 17.4
MAMAW/KEEW/ATHAB 16.2
CHINOOK RHA 15.3
PALLISER 15.1
CALGARY 12.8
DAVID THOMPSON 14.7
EAST CENTRAL 14.9
CAPITAL HEALTH 15.5
ASPEN 21.1
PEACE COUNTY 17.0
NORTHERN LIGHTS 17.4
EAST KOOTENAY 18.4
KOOTENAY-BOUND. 11.9
OKANAGAN 18.2
THOMPSON/CARIBOO 14.2
FRASER EAST 14.4
FRASER NORTH 12.2
FRASER SOUTH 12.4
RICHMOND 9.5
VANCOUVER 11.8
N. SHORE/C. GARI 11.5
S. VANCOUVER ISL 13.7
C. VANCOUVER ISL 15.5
N. VANCOUVER ISL 15.3
NORTHWEST 17.6
NORTH. INTERIOR 14.5
NORTHEAST 16.9
YUKON 13.9
NWT 14.1
NUNAVUT 16.5



Socio-demographic and socio-economic characteristics

Age-standardized prevalence rates are reported in this section. This was done to enable the comparison of rates between groups with different age structure.

The health benefits of relationships like marriage within society are well known.Footnote 51 Footnote 16 For example, married adults are generally found to be healthier than single or divorced adults.Footnote 15 Footnote 16 In keeping with this, the age-standardized prevalence of arthritis was significantly lower among men and women who were married/common law, compared to those who were widowed/separated/divorced (Figure 1-7). The higher rates of arthritis among separated and divorced people could result from the direct effect of arthritis on family dynamics or reduced family income, or from the higher rates of stress-related disability, job loss, and depression among those with arthritis, each of which could put stress on a marriage and lead to separation or divorce.

Figure 1-7: Age-standardized self-reported prevalence of arthritis, by marital status and sex, household population aged 15 years and older, Canada, 2007-2008

Figure 1-7 Age-standardized self-reported prevalence of arthritis, by marital status and sex, household poplation aged 15 years and older Canada 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-7
Figure 1-7: Age-standardized self-reported prevalence of arthritis, by marital status and sex, household population aged 15 years and older, Canada, 2007-2008
Marital Status Men (%) Women (%)
Married/Common-law 13.0 16.0
Single 12.7 16.0
Widowed/Separated/Divorced 14.9 18.5



Ethnicity has been identified as a factor associated with arthritis. The age-standardized prevalence of arthritis for Caucasian, Black, Asian and other ethnic groups is illustrated in Figure 1-8. The prevalence rates of arthritis among people from Asian origins were statistically lower than in people of Caucasian origin.

For information about arthritis among First Nations, Inuit and Métis populations, see Chapter 4.

Figure 1-8: Age-standardized self-reported prevalence of arthritis for Caucasian, Black, Asian and other ethnic groups by sex, household population aged 15 years and over, Canada, 2007-2008

Figure 1-8 Age-standardized self-reported prevalence of arthritis for Caucasian, aged 15 years and over, Canada, 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada.
E – interpret with caution.
‘Other’ category – excludes First Nations, Inuit and Metis populations.

Text Equivalent - Figure 1-8
Figure 1-8: Age-standardized self-reported prevalence of arthritis for Caucasian, Black, Asian and other ethnic groups by sex, household population aged 15 years and over, Canada, 2007-2008
Ethnicity Men (%) Women (%)
Caucasian 11.9 16.6
Black 6.8 13.4
Asian 7.0 12.8
Other 7.4 16.9



Men and women with less than secondary school education were more likely to report having arthritis compared to all other levels of education (Figure 1-9).

Figure 1-9: Age-standardized self-reported prevalence of arthritis, by level of education and sex, household population aged 15 years and over, Canada 2007-2008

Figure 1-9: Age-standardized self-reported prevalence of arthritis, by level of education and sex, household population aged 15 years and over Canada, 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-9
Figure 1-9: Age-standardized self-reported prevalence of arthritis, by level of education and sex, household population aged 15 years and over, Canada 2007-2008
Highest level of education Men (%) Women (%)
Less than secondary 15.1 21.4
Secondary graduate 11.1 16.4
Some post-secondary 11.7 17.7
Post-secondary graduate 10.4 15.5



The prevalence of arthritis was significantly higher among women and men with low / low middle income compared to all other income levels (Figure 1-10).

The association between self-reported arthritis and individual level of education and socio-economic status is well established. However, whether arthritis primarily affects those of low socio-economic status or leads to a lower socio-economic status is unknown.Footnote 9 Footnote 17 Footnote 18 These findings may result from differences in the prevalence of risk factors, as a lower socioeconomic status has been linked with inactivity and obesity, both established risk factors for certain types of arthritis. As well, disability associated with arthritis may reduce the opportunities for higher education and employment.

Figure 1-10: Age-standardized self-reported prevalence of arthritis, by income and sex, household population aged 15 years and over, Canada, 2007-2008

Figure 1-10: Age-standardized self-reported prevalence of arthritis, by income and sex, household population aged 15 years and over, Canada, 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-10
Figure 1-10: Age-standardized self-reported prevalence of arthritis, by income and sex, household population aged 15 years and over, Canada, 2007-2008
Income category Men (%) Women (%)
Low / low middle 13.0 18.4
Middle 10.9 15.7
Upper middle 10.6 15.0
Upper 10.3 14.5



The age-standardized prevalence of arthritis was significantly lower among immigrants than among people who were Canadian-born (Figure 1-11). This may be partly due to the healthy immigrant effectFootnote 1b*. Women reported a higher prevalence than men in both immigrant (14% versus 9%) and non-immigrant populations (17% versus 12%).

Figure 1-12 illustrates the impact of time since immigration on the prevalence of arthritis among immigrants. The age-standardized prevalence of arthritis was much lower among recent immigrants (less than 15 years since immigration) than those who immigrated 15 years ago or more. The more time since immigration the more similar the prevalence rates of arthritis became to non-immigrant, particularly among women. These findings are consistent with results from the Canadian literature.Footnote 9 Studies reported a narrowing of the health status gap in Canada between individuals who are native born and immigrants as their years in Canada increase — a worsening of immigrant health over time. Some researchers hypothesize that convergence in health outcomes might arise from a process of acculturation, in which recent immigrants gradually take on the characteristics of their "new" society.Footnote 9

Figure 1-11: Age-standardized self-reported prevalence of arthritis, by immigration status and sex, household population aged 15 years and over, Canada, 2007-2008

Figure 1-11: Age-standardized self-reported prevalence of arthritis, by immigration status and sex, household population aged 15 and over, Canada, 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-11
Figure 1-11: Age-standardized self-reported prevalence of arthritis, by immigration status and sex, household population aged 15 years and over, Canada, 2007-2008
Immigration status Men (%) Women (%)
Immigrant 8.9 14.5
Not an immigrant 12.3 16.9



Figure 1-12: Age-standardized self-reported prevalence of arthritis, by time since immigration and sex, household population aged 15 years and over, Canada, 2007-2008

Figure 1-12: Age-standardized self-reported prevalence of arthritis, by time since immigration and sex, household population aged 15 years and over, Canada, 2007-2008

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada
E – interpret with caution.

Text Equivalent - Figure 1-12
Figure 1-12: Age-standardized self-reported prevalence of arthritis, by time since immigration and sex, household population aged 15 years and over, Canada, 2007-2008
Time since immigration Men (%) Women (%)
< 15 years 5.1 8.9
≥ 15 years 9.7 15.9
Not an immigrant 12.3 16.9



Projections of arthritis prevalence

As previously shown (Figure 1-2), the prevalence of arthritis in Canada increases with age. Given the aging of the Canadian population, this pattern has significant implications for the future impact of arthritis in Canada. Canada's population is aging so quickly that in approximately a decade senior citizens will outnumber children.Footnote 19

The prevalence of arthritis is projected to increase by nearly one percentage point every five years over the next quarter century. By 2031, the prevalence of arthritis is projected to be 20% (Table 1-3), which would represent an increase of approximately 38% from 2007. It is estimated that by 2031, 6.7 million Canadians aged 15 years and older will have arthritis, with the largest increases in the older age groups, particularly among those aged 65 years and older due to an increasing number of older people (Figure 1-13). An increase is also noted in the working-age population (35-64 years of age), particularly among those aged 55-64 years.

Table 1-3. ProjectedTable 3 - Footnote * number of individuals aged 15 years and over with arthritis and prevalence of the condition, by sex, Canada, 2007-2031
Year Number of Men with Arthritis Prevalence of Men Number of Women with Arthritis Prevalence of Women Total Number of Men and Women with Arthritis Prevalence of Men and Women

Source: Arthritis Community Research and Evaluation Unit using Canadian Community Health Survey 2007, Statistics Canada.

*Based on medium population growth scenario.
2007 1,627,000 12.5% 2,564,000 19.0 % 4,191,000 15.8%
2011 1,838,000 13.1% 2,922,000 20.2 % 4,761,000 16.7%
2016 2,033,000 13.9% 3,218,000 21.2 % 5,251,000 17.6%
2021 2,232,000 14.6% 3,523,000 22.3 % 5,755,000 18.5%
2026 2,427,000 15.4% 3,827,000 23.3 % 6,254,000 19.4%
2031 2,607,000 16.0% 4,116,000 24.2 % 6,723,000 20.2%

Text Equivalent - Table 1-3

Table 1-3

The projected number of individuals aged 15 years and over with arthritis, and prevalence of the condition, by sex, from 2007-2031 are presented in Table 1-3. These projections are based on medium population growth scenario.

The prevalence of arthritis is projected to increase by nearly one percentage point every five years over the next quarter century.  By 2031, the prevalence of arthritis is projected to be 20%, which would represent an increase of approximately 38% from 2007.  It is estimated that by 2031, 6.7 million Canadians aged 15 years and older will have arthritis.

Source: Arthritis Community Research and Evaluation Unit, using Canadian Community Health



While these prevalence projections show similar trends to previously published estimates, a change in the arthritis question in the 2007 CCHS, as compared to previous surveys, resulted in slightly lower overall estimates, as expected.Footnote 2 Furthermore, these projections may, in fact, be conservative due to the assumptions made regarding the stability of the age- and sex-specific prevalence estimates as well as of the prevalence of associated risk factors, such as obesity, over time.

Figure 1-13: Number of people projected to have arthritis, by year and age group, Canada 2007-2031

Figure 1-13: Number of people projected to have arthritis, by year and age group, Canada 2007-2031)

Source: Public Health Agency of Canada using Canadian Community Health Survey, 2007-2008, Statistics Canada

Text Equivalent - Figure 1-13
Figure 1-13: Number ('000s) of people projected to have arthritis, by year and age group, Canada 2007-2031
Age group 2007 2011 2016 2021 2026 2031
15-24 52 55 53 50 50 51
25-34 137 143 148 150 146 141
35-44 392 382 391 412 427 435
45-54 813 859 821 776 797 840
55-64 1045 1220 1368 1460 1402 1332
65-74 898 996 1260 1505 1699 1822
75+ 853 1105 1209 1402 1733 2101



Summary

  • The word “arthritis” is used to describe more than 100 rheumatic diseases and conditions that affect a joint or joints, causing pain, swelling and stiffness which often lead to disability.
  • Common types of arthritis include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psori- atic arthritis, systemic lupus erythematosus, gout, and childhood or juvenile idiopathic arthritis.
  • In 2007-2008, over 4.2 million Canadians (16%) aged 15 years and older reported to have arthritis.
  • On the basis of current projections, 1 million more Canadians will have arthritis within 10 years. In 20 years, the prevalence of arthritis may reach one in five Canadians.
  • Close to three in five people (58%) with arthritis are under 65 years. Loss of both work and productivity are frequent and occur early, due to disability. This may impact participation in the labour force.
  • The crude prevalence of arthritis varied considerably across Canada ranging from 23% in Nova Scotia to 12% in Quebec and 11% in the Territories (Yukon, Northwest Territories and Nunavut). Age-standardized prevalence estimates for Newfoundland and Labrador and Nova Scotia were significantly higher (1.1-1.3 times) than the national prevalence whereas, Quebec and British Columbia were significantly lower (0.6-0.9 times). Variations in socio-economic status, body mass index and ethnic composition could contribute to the observed differences between the provinces and territories.
  • Prevalence of arthritis was higher among people who have lower formal education levels and report low income levels.
  • The age-standardized prevalence of arthritis was significantly lower among immigrants compared to Canadian-born people. However, the age- standardized prevalence of arthritis was much lower among recent immigrants (less than 15 years since immigration) than those who immigrated 15 years ago or more. The more time since immigration the more similar the prevalence rates of arthritis became to non-immigrant, particularly among women.

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