List of tables: Life with arthritis in Canada: a personal and public health challenge
List of tables
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.
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.
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 HealthSurvey 2007, Statistics Canada.
A summary of the available literature on the risk factors (non-modifiable and modifiable) associated with arthritis is presented in Table 2-1.
Proportion of individuals aged 15 years and over with disability due to arthritis who reported limitations in mobility, by age and sex, in 2001 is presented in Table 3-1.
Over 30% of men and women with activity limitations due to arthritis reported difficulty with or used assistance in moving around. Women had significantly greater difficulty in climbing stairs, standing for twenty minutes, and moving room-to-room or walking ½ km than men whereas, similar proportions of women and men reported needing or using assistance in walking. People of working age (aged less than 65 years) had either similar or more difficulties with climbing stairs, standing for 20 minutes and moving room to room or walking ½ km compared to those aged over 65 years.
In all age groups, women with arthritis were more likely than men with arthritis to have difficulty reaching, grasping or carrying (68-76% versus 55-64%, respectively). They were also more likely than men to report the use of assistance with these tasks (12-26% versus 5-10%, respectively). These limitations due to arthritis were not restricted to the older age groups. Individuals of working age (15-64 years) were equally or more likely than individuals aged 65 years and over to report having difficulty reaching or bending due to their arthritis.
Use of transportation was problematic for young people with disability due to arthritis. Men and women aged 15-44 years were more likely than the other age groups to report difficulties with transportation. The use of distance transportation was particularly challenging for young people, with close to 60% of them reporting difficulties in this area. Over a quarter of people of working age reported having difficulties traveling locally by car, which could impact their participation in the workforce or in social life. Similar proportions of men and women reported difficulty with the use of different transportation modes.
Source: Arthritis Community Research and Evaluation Unit using data from the Participation and Activity Limitation Survey 2001, Public Use File, Statistics Canada.
Proportion of individuals aged 15 years and over, with disability due to arthritis who reported limitations in self-care, by age and sex, in 2001 is presented in Table 3-2.
Overall, similar proportions of men and women reported difficulties with self-care activities. Over 30% of men and women aged 15-64 years reported needing help to get in and out of bed, which is higher than among those aged 65 years and over (up to 19%).Source: Arthritis Community Research and Evaluation Unit using data from the Participation and Activity Limitation Survey 2001, Public Use File, Statistics Canada.
Proportion of individuals aged 15 years and over with disability due to arthritis who reported limitations in participating in community, social and civic life, by age and sex, in 2001 is presented in Table 3-3.
Over 50% of those with activity limitations due to arthritis reported difficulties in participating in physical activities and in out-of-home leisure activities. Over 65% of men and women aged 15-44 years reported a limitation in their participation in weekly leisure activities outside the home and up to 63% reported difficulties doing daily exercise or physical activity. The same pattern was observed among those aged 45-64 years of age.Source: Arthritis Community Research and Evaluation Unit using data from the Participation and Activity Limitation Survey 2001, Public Use File, Statistics Canada.
The total number of arthritis deaths, by type of arthritis, in 2005 is presented in Table 5-1.
Of the five categories of arthritis conditions, two accounted for over 60% of the total arthritis deaths: connective tissue diseases such as lupus (34%), and rheumatoid arthritis (30%). Among deaths from connective tissue diseases, most were due to lupus or to systemic sclerosis/scleroderma which are two of the less common type of arthritis conditions.
Source: Public Health Agency of Canada, using 2005 Canadian Annual Mortality data, Statistics Canada.
The number and proportion of arthritis premature deaths, by sex and type of arthritis, in 2005 are presented
in Table 5-2.
Forty percent of people who died from arthritis (430 deaths) died prematurely (before the age of 75) which is similar to the percentage of Canadians who died prematurely of all causes (39%). Over eighty percent of premature deaths related to arthritis were due to connective tissue diseases (57%) and rheumatoid arthritis (26%). Among men, 49% of premature deaths were due to connective tissue diseases versus 61% among women, and 23% were due to rheumatoid arthritis in men compared to 27% for women.Source: Public Health Agency of Canada, using 2005 Canadian annual mortality data, Statistics Canada.
The economic burden of arthritis, by cost components, in 2000 (and 2008) dollars is presented in Table 6-1. Short term disability costs were not available for arthritis but were included in musculoskeletal disease.
In 2000, the total cost of musculoskeletal diseases which includes arthritis (ICD-9 710-739, 274) was $22.3 billion and the most costly group of diseases. The economic burden of arthritis (ICD-9 99.3, 274, 696.0, 446, 710.0-710.4, 710.9, 711-720, 725-729) in Canada was estimated to be $6.4 billion, representing almost one third of the total cost of musculoskeletal diseases.
Indirect costs associated with arthritis accounted for twice the direct costs ($4.3 billion and $2.1 billion, respectively). With respect to direct costs, arthritis accounted for over one half of hospital care expenditures for all musculoskeletal diseases, nearly three fifths of drug expenditures, and approximately one half of physician care expenditures. For indirect costs, arthritis accounted for more than 80% of all musculoskeletal mortality costs and over one quarter of morbidity costs due to long-term disability.
Morbidity costs ($4.1 billion) due to long-term disability accounted for nearly two thirds of total arthritis costs in 2000, by far the largest cost component of the arthritis burden. The largest direct cost components were hospital care expenditures ($987 million) and physician care expenditures ($589 million).Source: Public Health Agency of Canada, Economic Burden of Illness in Canada 2000 custom tabulations.
Number and percentage of non-steroidal anti-inflammatory drug (NSAID), disease modifying anti-rheumatic drug (DMARD), corticosteroid, biologic response modifier and gastrointestinal (GI) protective agent prescriptions written for individuals aged 15 years and over with arthritis, in 2007 are presented in Table 7-1.
In 2007, over 4 million prescriptions for NSAIDs were written in Canada for individuals with a diagnosis of arthritis—the largest number among all categories of arthritis-related prescriptions. Nearly one third (30%) of NSAID prescriptions for arthritis were written for people diagnosed with osteoarthritis, 9% were written for those diagnosed with rheumatoid arthritis, connective tissues diseases and other inflammatory arthritis and the remaining 61% were written for other types of arthritis such as, joint derangements, polymyalgia rheumatica, synovitis, bursitis, and unspecified arthropathies.
Most of the GI protective agent prescriptions were either written for people with osteoarthritis or for people with any of the other arthritis conditions (40% and 53%, respectively).
DMARDs are also commonly used among individuals with arthritis with over 1 million prescriptions written for people with arthritis in 2007. The majority (over 70%) of the 1 million DMARDs prescriptions were written for individuals with a diagnosis of rheumatoid arthritis.
Corticosteroids prescriptions (62%) were most commonly written for those with a diagnosis that fell in the other arthritis conditions category.
Over 90% of biologic response modifier prescriptions were written for individuals diagnosed with rheumatoid arthritis.Source: Public Health Agency of Canada, using data from the Canadian Disease and Therapeutic Index (CDTI), IMS Health Canada.
Visits to all physicians for arthritis and related conditions, among adults aged 15 years and older, in Canada (excluding the territories), in 2005-2006 are presented in Table 8-1. Individuals with at least one ambulatory encounter for which the physician claim contained an arthritis diagnostic code were included in the analyses. For the estimated total number of visits, a Canadian rate was calculated using data from the participating provinces, and visits for non-participating provinces were estimated by applying this rate to the respective 2005 provincial populations.
In 2005-2006, the total number of arthritis-related visits in Canada (excluding the territories) was estimated to be 8.5 million. Approximately 14% of Canadians 15 years and older made at least one visit to a physician with a diagnosis of arthritis. On average, 2.3 arthritis-related visits per person were made during 2005-2006 and more women than men consulted a physician for arthritis (women to men ratio 1.4:1). Approximately 5% of the Canadian population made at least one physician visit with a recorded diagnosis of osteoarthritis (30% of all arthritis visits). Less than one percent of Canadians (0.6%) visited a physician for rheumatoid arthritis. On average, 2.0 visits per person were made for osteoarthritis and 3.2 visits per person were made for rheumatoid arthritis during 2005-2006. Women visited a physician 1.7 times more often than men for osteoarthritis and 2.5 times more often than men for rheumatoid arthritis.Source: Public Health Agency of Canada using provincial physician billing data (Alberta, Manitoba, Ontario, Quebec, Nova Scotia).
Age- and sex-standardized rate of joint replacement per 100,000 population, by province of residence, from 2001/02 and 2005/06 are presented in Table 9-1. Data were not reportable in the territories for ‘other’ joint replacements due to small numbers.
Rates of hip and knee replacements varied considerably by province in 2001/02 and 2005/06. Rates in Quebec and Newfoundland and Labrador were the lowest among all jurisdictions. With the exception of the Territories, the hip and knee replacement rates increased in all provinces between 2001/02 and 2005/06.Source: Arthritis Community Research Evaluation Unit using Hospital Morbidity Database (HMDB), Canadian Institute for Health Information (CIHI).
Data sources: Table 1
The arthritis International Classification of Diseases (ICD) 9/10 codes used in Chapters 5 and 7 are presented in this table.
Data sources: Table 2
The arthritis International Classification of Diseases (ICD) 9/10 codes used in Chapter 8 are presented in this table.
Data sources: Table 3
The arthritis International Classification of Diseases (ICD) 9/10 codes used in Chapter 9 are presented in this table.
Data sources: Table 4
The Canadian Classification of Health Interventions (CCI) and the Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures (CPP) codes for joint replacement surgery used in Chapter 9 are presented in this table.
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