Global, regional and national burden of rheumatoid arthritis from 1990 to 2021, with projections of incidence to 2050: a systematic and comprehensive analysis of the Global Burden of Disease study 2021

Abstract

Background: To provide insights into rheumatoid arthritis (RA) epidemiological trends, including prevalence, incidence, disability-adjusted life years (DALYs), corresponding average annual percentage change (AAPC), gender disparities, regional variations, age-specific rates, socio-economic correlations, risk factors, and future projections.

Methods: Data were extracted from the Global Burden of Disease Study (GBD) 2021. AAPC was calculated by joinpoint regression and two-sample Mendelian randomization (MR) analysis was performed to verify the causal relationship between the smoking factor and RA. The future incidence trend was predicted by the Bayesian age-period-cohort (BAPC) model.

Results: Global age-standardized prevalence rate (ASPR) and age-standardized incidence rate (ASIR) increased significantly while age-standardized DALYs rate (ASDR) decreased from 1990 to 2021. Regional variations were pronounced, with Andean Latin America reporting the highest burden. Females consistently exhibited higher age-standardized rate (ASR) across all metrics. Age-specific prevalence, incidence, and DALYs rates peaked at different age groups, highlighting complex demographic dynamics. Socio-demographic index (SDI) analysis demonstrated a positive correlation between RA burden and socio-economic development. The two-sample MR analysis confirmed a causal effect between smoking and RA. From 2022 to 2050, the ASIR will increase moderately.

Conclusions: The study underscores the escalating burden of RA globally, emphasizing the need for healthcare providers to be aware of the effects of aging populations and other societal factors on the risk of developing RA, and to develop targeted interventions, including smoking cessation programs, age- and gender-appropriate healthcare, and early diagnosis strategies.

Keywords: Autoimmune disease; Global burden of disease; Public health; Rheumatoid arthritis.

Fig. 1

Global map of ASPR of RA categorized by ASPR quintiles for both sexes (a), change in prevalence cases quintiles for both sexes (b), and corresponding AAPC from 1990 to 2021 for both sexes (c). ASPR, age-standardized prevalence rate; RA, rheumatoid arthritis; AAPC, average annual percentage change

Fig. 2

Association between SDI and ASPR (a), ASIR (b) and ASDR (c) of RA in 2021 and corresponding AAPC (d, e, f) from 1990 to 2021. Dotted lines refer to the global level of rates (a, b, c) and zero (d, e, f), respectively. SDI, socio-demographic index; ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASDR, age-standardized DALYs rate; DALYs, Disability-Adjusted Life Years; RA, rheumatoid arthritis; AAPC, average annual percentage change

Fig. 3

Temporal trend of ASPR, ASIR, and ASDR for the burden of RA, globally and by SDI (five levels: high, high-middle, middle, low-middle, and low SDI) from 1990 to 2021. The AAPC, globally and by SDI levels, from 1990 to 2021 is also shown. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASDR, age-standardized DALYs rate; DALYs, Disability-Adjusted Life Years; RA, rheumatoid arthritis; SDI, socio-demographic index; AAPC, average annual percentage change

Fig. 4

Global number of prevalent cases and age-specific prevalence rate (a), number of incidence cases and age-specific incidence rate (b), and DALYs and age-specific DALYs rate (c) of RA per 100,000 population by age and sex in 2021; dotted and dashed lines indicate 95% upper and lower uncertainty intervals, respectively. DALYs, Disability-Adjusted Life Years; RA, rheumatoid arthritis

Fig. 5

Proportion of RA DALYs attributable to smoking risk factor globally and in 26 GBD regions; combined in year (a) and sex (b), and forest plot of MR analysis combined in (c) the association of smoking initiation with risk of RA and (d) the association of current tobacco smoking with risk of RA. RA, rheumatoid arthritis; GBD, Global Burden of Disease Study; DALYs, Disability-Adjusted Life Years; MR, Mendelian randomization; OR, odds ratio; SNP, single nucleotide polymorphism

Fig. 6

Global ASIR of RA from 1990 through 2050 forecasts in males (a) and females (b) predicted by BAPC model. The shaded area represents 95% CI. ASIR, age-standardized incidence rate; RA, rheumatoid arthritis; BAPC, Bayesian age-period-cohort; CI, confidence interval