Title: Determining the burden of hipknee osteoarthritis and rheumatoid arthritis using disabilityadjusted l
1Determining the burden of hip/knee osteoarthritis
and rheumatoid arthritis using
disability-adjusted life-years (DALYs)United
States, 1996
Arthritis Program
2Charles G. Helmick, MDCatherine Michaud, MD,
PhDMargaret Lethbridge-Cejku, PhDJennifer
Hootman, PhDMeghna Majmudar
Arthritis Program
3Arthritis--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
4Leading 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
5The 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)?
6Methods--Outcome
- DALYs (disability adjusted life years)
- mortality (YLL)
- disability (YLD)
7Methods
- Focus on 2 arthritis conditions
- Hip/knee osteoarthritis
- Rheumatoid arthritis
- Determine absolute DALYs
- Determine relative ranking
8Methods--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
9Methods--Rheumatoid arthritis
- Incidence of rheumatoid arthritis
- GBD disability weight 0.186
- untreated 0.233
- treated 0.174
- no age/sex specific weights
10Results--hip/knee osteoarthritis
- US
- DALYs Rank total
- Overall 941,321 10th 2.83
- Women 507,098 7th 3.31
- Men 434,223 13th 2.42
11Results--rheumatoid arthritis
- US
- DALYs Rank
- Overall 201,676 gt20th
- Women 140,929 gt20th
- Men 60,747 gt20th
12Top 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
1311-20 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
14Discussion
- Strengths
- standard, summary measure (DALY)
- first US DALY estimates for arthritis
- Limitations
- many types of arthritis excluded
- limited data on prevalence, incidence,
distribution, weights
15Conclusions
- 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
16Conclusion
- arthritis remains a large absolute and relative
societal burden - arthritis interventions warrant greater attention
as a means of reducing disability