Disease Burden Of Arthritis In Shanghai

[BACKGROUND]Arthritis or rheumatic disease, that include more than 150 different conditions and syndromes with the common denominators of pain and inflammation, is one of noncommunicable diseases attracting much of the public's attention. Although it rarely induces death, arthritis is the major cause of morbidity throughout the world, having a substantial influence on patients' health and quality of life, and inflicting an enormous burden of cost on health systemsHowever there is less information on disease burden such as prevalence, quality of life and economic cost due to arthritis in population. Insufficient data of magnitude of the problem, such as population distribution, systemic assessment and economic burden is hardly to provide the evidence for developing priorities and strategies to control these conditions.[OBJECTIVE]The goal of study is to understand the disease burden of arthritis in Shanghai and to provide the evidence for intervention strategies to improve arthritis patients' health related quality of life. The specific objectives are as follows:1. To identify the prevalence of arthritis, to describe the characters of population distribution and to explore the arthritis related factors through cross-sectional survery.2. To identify the disease burden of arthritis by calculating disability adjusted life year of arthritis.3. To identify the economic burden of arthritis and which expenditures were influenced by caculating the economic expenditure of arthritis.4. To identify what influence arthritis put on the patients' health related quality of life and its extent by assessing the arthritis patients' health related qualityof life.[METHODS]In the study, cross-sectional survey and case-control study were employed.In cross-sectional survey, multi-stage cluster and stratification sampling method was employed to draw out sample population from denizens aged 15 years and older in 3 districts (Huangpu, Songjiang, Jinshan) in Shanghai. The data on social-demographic information, including age, gender, occupation, education, economic status, etc. and about arthritis related information, including disease history and symptom, and about other noncommunicable diseases information and about height and weight of the subjects were collected to obtain primary information of the population and to select out diagnosed and potential arthritis patients. Then the potential patents were organized to have clinical diagnosis to confirm the arthritis patients.The prevalence of arthritis in Shanghai was calculated out and 2000 census data in Shanghai was used as the standard population to standardize the prevalence. The arthritis characters of population distribution were described and the arthritis related factors were analyzed.Through the household survey, patients with arthritis were asked the first year when their symptom occurred or the first year when their arthritis was diagnosed so as to obtain the incidence age of the patients. The method named "trade-off in time" was employed to obtain disability weight. Based on the data, the incidence, disability weight and disability adjusted life year of arthritis were calculated.In the case-control study, diagnosed arthritis patients were matched with non-arthritis individuals according to matching criteria, to compare with economic burden and health related quality of life between arthritis patients and control population.In economic burden assessment, the patients were asked whether they went to see the doctor immediately when the symptom occurred and the causes why they did not do that, how many times they went to see doctor last month and the medical expenditure, how many days they were in hospital last years and the medical expenditure, how much the expenditure for drugs and supplements last month, the purchasing service expenses since sick lastmonth, the traveling expenses and time cost for going to the doctor every time, time cost for waiting to see the doctor every time, the days patient can?not go to work or go to school for sick last month, and the days family can not go to work for taking care of the patient last month, etc. From the collected information, the rate of going to see doctor immediately, the causes why did not go to see doctor immediately, the economic cost of arthritis in Shanghai were calculated out and the impact that arthritis put on the expenditure was analyzed.In health related quality of life assessment, the Medical Outcomes Study 36 -Item Short- Form Health Survey (SF-36) was used to get self-reported health data in 8 health domains and health transition from the arthritis patients and the control population, and the patients were required to rank the domains according to their importance to quality of life. Ordinal item response model was employed to analyze the data according to Item Response Theory (IRT) and the subjects' scores of health domains were predicted. Comparing the scores of arthritis patients and controls, the change in every domain was obtained, and the impact that arthritis put on the scores of health domains was analyzed, and the rank for every health domain was identified.[RESULTS]1. Standardized prevalence of arthritis in ShanghaiIn 15 years and older population, the overall prevalence of arthritis was 6.11%, the prevalence of osteoarthritis was 4.18%, the prevalence of rheumatoid arthritis was 0.52%, the prevalence of gout was 0.28%, the prevalence of ankylosing spondylitis was 0.28 %, and the prevalence of reactive arthritis was 0.49%.2. The proportion of arthritis in ShanghaiThe proportion of different types arthritis was 64.15% for osteoarthritis, 8.79% for rheumatoid arthritis, 6.68% for reactive arthritis, 5.45% for ankylosing spondylitis, 4.57% for gout, and 10.37% for other types of arthritis.3. The characters of arthritis in population distributionThe prevalence of arthritis increased with aging. The prevalence in female(7.95%) was higher than that in male (4.26%) . The prevalence in downtownareas (8.12%) was higher than that in outskirts (5.35%), and higher than thatin rural areas (2.10%) . The prevalence was highest in illiteracy population (12.05% ) , the prevalence in brainwork population were higher than in laborwork population, the prevalence was highest in medical insurance population (10.77%) , and the prevalence increased as body mass index increasing.4. Arthritis related factors analysisThe prevalence of arthritis was related with age, it was higher among elder population than among young population. The prevalnece of arthritis was related with gender, it was higher among female than among male, the odds ratio was 1.98. The prevalence of arthritis was related with overweight/obesity, it was higher among overweight/obesity population than normal weight population. The prevalnece of arthritis was related with occupation. Compared with labor worker, the prevalence was higher among officials, farmers and household worner:, the odds ratio was 1.71, 1.77 and 16.5 respectively. The prevalence of arthritis was lower among out of pocket population for medical expenditure than among medical insurance population. The prevalence of arthritis was different among the study areas. Compared with people living in Jinshan District, the prevalence was higher among people living in Songjiang District and among those living in Huangpu District, and the odds ratio was 2.43 and 2.66 respectively. Chronic gastric-intestinal diseases, heart diseases and chronic pulmonary diseases were significantly related with arthritis. Compared with non-patients, the odds ratio was 2.15, 1.87 and 1.51 respectively.5. The disability adjusted life year of arthritis in ShanghaiIt was found out that 90.7 thousand health life years were lost due to arthritis in 15 years and older population in Shanghai, in which male lost 27.8 thousand years and female lost 62.8 thousand years.There was 8.17 health life years per 1000 subjects per year lost resulted from arthritis in Shanghai. Male lost 4.99 years per 1000 subjects per year and female lost 11.40 years per 1000 subjects per year.There was 3.06 health life years per patient lost in his life resulted from arthritis in Shanghai. Male lost 2.61 years per patient in his life and female lost 3.32 years per patient in her life.6. The rate of going to see the doctor immediately and the cause why don'tdo thatThe rate of going to see the doctor immediately among the arthritis patients' was 59.60%. The dominant cause not to see the doctor immediatedly was "the symptom was not serious", other causes such as "unaffordable", "inconvenient to go to hospital", and "unwilling to wait for treatment" were mentioned.7. The outpatient times per patient per year for different types arthritisThe outpatient times per patient per year for general arthritis were 4.28 in Shanghai. For osteoarthritis were 4.97, for rheumatoid arthritis were 5.87, for gout were 5.42, for ankylosing spondylitis were 2.13, for reactive arthritis were 3.64.8. The economic cost Gf arthritis in ShanghaiIn 15 years and older population, the overall economic cost of arthritis was 4.12 billion (yuan). If unincluding the cost resulted from DALY, the overall economic cost of arthritis was 508 million (yuan) per year in Shanghai, in which, the direct cost was 400 million (yuan), that account for 78.73% and indirect cost was 108 million (yuan), that account for 21.27%. The cost of arthritis per patient per year was 748.59 yuan, the direct cost was 589.37 yuan and indirect cost was 159.23 yuan.The economic cost of arthritis resulted from DALY was 3.69 billion (yuan) per year, 3.62 billion (yuan) from disability and 64 million (yuan) from death.9. The expenditure impact from arthritisArthritis patients' economic expenditure can be divided as two parts, one is arthritis related economic expenditure and another is other diseases related economic expenditure. In total disease expenditure, arthritis increased outpatient expenditure and the time cost waiting for treatment. In other diseases related economic expenditure, arthritis also increased outpatient expenditure and the time cost waiting for treatment.10. The scores of health domains were compared between arthritis patients and controlsConsidering the scores of health domains in general, healthy controls were higher than the controls with chronic disease, and higher than arthritis patients without other chronic diseases, and higher than arthritis patient with...