National burden of rheumatoid arthritis in Canada, 1990-2019: findings from the Global Burden of Disease Study 2019 - a GBD collaborator-led study.

The objectives of this study were: (1) to describe burden of rheumatoid arthritis (RA) and trends from 1990 to 2019 using the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) data, (2) to describe age and sex differences in RA and (3) to compare Canada's RA burden to that of other countries. Disease burden indicators included prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life-years (DALYs). GBD estimated fatal and non-fatal outcomes using published literature, survey data and health insurance claims. Data were analysed by Bayesian meta-regression, cause of death ensemble model and other statistical methods. DALYs for Canada were compared with DALYs of countries with similarly high Socio-Demographic Index values. In Canada, the RA prevalence rate increased by 27% between 1990 and 2019, mortality rate decreased by 27%, YLL rate decreased by 30%, YLD increased by 27% and DALY rate increased by 13%, all age standardised. The decline in RA mortality and YLL rates was especially pronounced after 2002. The disease burden was higher in females for all indicators, and DALY rates were higher among older age groups, peaking at age 75-79 years. Prevalence and DALYs were higher in Canada compared with global rates. Trends in RA burden indicators over time and differences by age and sex have important implications for Canadian policy-makers, researchers and care providers. Early identification and management of RA in women may help reduce the overall burden of RA in Canada.

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Competing interests: JJH reports receiving clinical research grants from the New Brunswick Health Research Foundation and Canadian Chiropractic Research Foundation; all outside the submitted work. IOI reports receiving clinical research grants from the Canadian Institutes for Health Research–CIHR Frederick Banting and Charles Best Canadian Graduate School Doctoral Fellowship and The University of British Columbia Four Year Fellowship (4YF); all outside the submitted work. MM reports grants or contracts from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 712949 (TECNIOspring PLUS), grants or contracts from the Agency for Business Competitiveness of the Government of Catalonia (TECSPR18-10017), a salary from TECNIOspring PLUS, and a salary as a professor of biostatistics from Isfahan University of Medical Sciences; all outside the submitted work. OPK reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with ERS Epidemiology Group Chair; all outside the submitted work. RS reports receiving clinical research grants from the Cystic Fibrosis Foundation, Canadian Institutes for Health Research; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Vertex pharmaceuticals–cystic fibrosis educational sessions, ad board; participation on a Data Safety Monitoring Board or Advisory Board with Oncovir DSMB; all outside the submitted work.