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Determining the burden of hipknee osteoarthritis and rheumatoid arthritis using disabilityadjusted l

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100 types of arthritis and other rheumatic conditions ... 6. chronic obstructive pulmonary disease 3.8. 7. alcohol use 3.5. 8. HIV/AIDS 2.9. 9. diabetes 2.9 ... – PowerPoint PPT presentation

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Title: Determining the burden of hipknee osteoarthritis and rheumatoid arthritis using disabilityadjusted l


1
Determining the burden of hip/knee osteoarthritis
and rheumatoid arthritis using
disability-adjusted life-years (DALYs)United
States, 1996
Arthritis Program
2
Charles G. Helmick, MDCatherine Michaud, MD,
PhDMargaret Lethbridge-Cejku, PhDJennifer
Hootman, PhDMeghna Majmudar
Arthritis Program
3
Arthritis--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

4
Leading 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
5
The 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)?

6
Methods--Outcome
  • DALYs (disability adjusted life years)
  • mortality (YLL)
  • disability (YLD)

7
Methods
  • Focus on 2 arthritis conditions
  • Hip/knee osteoarthritis
  • Rheumatoid arthritis
  • Determine absolute DALYs
  • Determine relative ranking

8
Methods--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

9
Methods--Rheumatoid arthritis
  • Incidence of rheumatoid arthritis
  • GBD disability weight 0.186
  • untreated 0.233
  • treated 0.174
  • no age/sex specific weights

10
Results--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

11
Results--rheumatoid arthritis
  • US
  • DALYs Rank
  • Overall 201,676 gt20th
  • Women 140,929 gt20th
  • Men 60,747 gt20th

12
Top 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

13
11-20 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

14
Discussion
  • Strengths
  • standard, summary measure (DALY)
  • first US DALY estimates for arthritis
  • Limitations
  • many types of arthritis excluded
  • limited data on prevalence, incidence,
    distribution, weights

15
Conclusions
  • 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

16
Conclusion
  • arthritis remains a large absolute and relative
    societal burden
  • arthritis interventions warrant greater attention
    as a means of reducing disability
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