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. 2025 Oct 9:12:1664232.
doi: 10.3389/fmed.2025.1664232. eCollection 2025.

Unveiling health inequalities and frontier gaps in elderly-onset rheumatoid arthritis: evolving impact of smoking and future challenges

Yan Gao #  1 , Chen Jia #  1 , Hailong Yu  2 , Wenfeng Han  2 , Ning Wang  2 , Bin Zheng  2 , Aoxiang Yang  2 , Yu Wang  2
Affiliations

Unveiling health inequalities and frontier gaps in elderly-onset rheumatoid arthritis: evolving impact of smoking and future challenges

Yan Gao et al. Front Med (Lausanne). .

Abstract

Background: Elderly-onset rheumatoid arthritis (EORA) poses a growing public health burden worldwide. Significant health inequalities and frontier gaps persist across countries, while the impact of smoking on EORA has evolved over time.

Methods: Using data from the 2021 Global Burden of Disease data, we assessed the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of EORA and analyzed trends by calculating the estimated annual percentage changes. We explored associations with the sociodemographic index (SDI), evaluated frontier gaps, quantified health inequalities, examined the impact of smoking, and predicted trends to 2050 using Bayesian age-period-cohort (BAPC) models.

Results: In 2021, global EORA case numbers were as follows: incidence: 0.33 million (95% uncertainty interval [UI]: 0.22, 0.47), prevalence: 7.92 million (95% UI: 6.90, 9.10), mortality: 33.20 thousand (95% UI: 26.86, 38.57), and DALYs: 1.55 million (95% UI: 1.23, 1.93). The disease burden was higher in females than in males, with high SDI-regions such as Australia experiencing the highest burden. Trends varied across different regions and countries; India and China had the highest case numbers, whereas Guam and Singapore showed significant improvements in mortality rates. Cross-national inequality analysis revealed significant disparities in disease burden. Frontier analysis identified considerable potential for improvement in disease burden in several countries and regions. The impact of smoking on EORA has declined, but BAPC model projections indicate that the burden will continue to rise until 2050.

Conclusion: Elderly-onset rheumatoid arthritis has become a significant public health concern. Addressing socio-economic inequalities, enhancing monitoring systems, and implementing targeted prevention and treatment strategies are crucial for alleviating the global EORA burden.

Keywords: disability-adjusted life years; global burden of disease study; incidence; mortality; prevalence; rheumatoid arthritis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Four line graphs labeled A, B, C, and D, each showing data trends from 1990 and 2021 for different regions. Graph A displays incidence numbers, B shows prevalence numbers, C represents death numbers, and D illustrates DALY numbers. Each graph includes shaded areas indicating uncertainty, bar graphs for number comparisons, and lines for rate changes, with regions like Global, High-income Asia Pacific, and Central Sub-Saharan Africa mentioned.
FIGURE 1
The number of cases and their ASRs for Incidence, Prevalence, Death, and DALYs. (A) Incidence; (B) Prevalence; (C) Mortality; (D) DALYs. ASR, age-standardized rate; DALYs, disability-adjusted life years; EORA, elderly-onset rheumatoid arthritis; SDI, sociodemographic index; GBD, global burden of disease.
Four colored world maps labeled A, B, C, and D display age-standardized rates from 1990 to 2021. They show estimated annual percentage changes (EAPC) for: A - Age-Standardized Incidence Rate (ASIR); B - Age-Standardized Prevalence Rate (ASPR); C - Age-Standardized Mortality Rate (ASMR); D - Age-Standardized Disability-Adjusted Life Year Rate (ASDR). Color gradients indicate the magnitude of EAPC, with red representing higher rates and blue representing lower rates. Each map includes a legend detailing EAPC ranges.
FIGURE 2
Estimated annual percentage change of ASR for EORA in 204 Countries and Territories (1990–2021). (A) EAPC of ASIR; (B) EAPC of ASPR; (C) EAPC of ASMR; (D) EAPC of ASDR. ASR, age-standardized rate; EORA, elderly-onset rheumatoid arthritis; EAPC, estimated annual percentage change; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life years rate.
Grid of eight horizontal bar charts displays the global and regional prevalence rates per one hundred thousand for various age groups categorized by sociodemographic index (SDI) levels: global, high, high-middle, middle, low-middle, and low. Each chart contrasts rates across different age groups, such as 65-69 years, 70-74 years, up to 95-99 years, with data points for males and females. The year is 1990 versus 2021.
FIGURE 3
Age-standardized prevalence rates of EORA by sex, age group, and socio-demographic index; 1990 and 2021. EORA, elderly-onset rheumatoid arthritis.
Panels A, C, E, and G show scatter plots of absolute inequality by relative rank with trend lines. Panels B, D, F, and H display line graphs of cumulative incidence against ranked population fractions. Data covers years 2017 and 2021, showing trends in health inequality metrics across regions with varying socioeconomic statuses. The diagrams include annotations of key data points and indices.
FIGURE 4
Health inequality regression curves and concentration curves for global EORA in 1990 and 2021. (A,B) Incidence; (C,D) Prevalence; (E,F) Mortality; (G,H) DALYs. DALYs, disability-adjusted life years; EORA, elderly-onset rheumatoid arthritis.
Eight scatter plots (A-H) display age-standardized mortality rates (ASMR) per 100,000 against the Social Development Index (SDI) for different years (1990, 2000, 2010, 2019) with varying color gradients. Plots A, C, E, and G show trends over time, while plots B, D, F, and H compare increases and decreases in specific regions or countries. Each plot highlights how higher SDI typically correlates with lower ASMR, using distinct color gradations to represent different years. Trends in mortality rates and development are evident across various countries and regions.
FIGURE 5
Frontier analysis explored the relationship between the sociodemographic index and ASRs of EORA. (A,B) Incidence; (C,D) Prevalence; (E,F) Mortality; (G,H) DALYs. ASR, age-standardised rate; DALYs, disability-adjusted life years; EORA, elderly-onset rheumatoid arthritis.
Twelve line graphs depict projected age-standardized incidence rates (ASIR) per 100,000 people from 1990 to 2050. The graphs are divided into three columns labeled “Both,” “Male,” and “Female,” each showcasing different colored trends: purple for both, blue for males, and orange for females. Each row illustrates different ASIR values over time, with data splitting into future projections after 2020. The trend lines show varying rates of increase.
FIGURE 6
Age-standardiszed rates of EORA from 1990 to 2050 based on the BAPC model, stratified by sex. ASR, age-standardized rate; DALYs, disability-adjusted life years; EORA, elderly-onset rheumatoid arthritis; BAPC, Bayesian age-period cohort.
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References

    1. Sherrer Y, Bloch D, Mitchell D, Young D, Fries J. The development of disability in rheumatoid arthritis. Arthritis Rheum. (1986) 29:494–500. 10.1002/art.1780290406 - DOI - PubMed
    1. Brown P, Pratt A, Hyrich K. Therapeutic advances in rheumatoid arthritis. BMJ. (2024) 384:e070856. 10.1136/bmj-2022-070856 - DOI - PubMed
    1. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. (2020) 396:1204–22. 10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
    1. Jeon K, Han K, Jung J, Park C, Eun Y, Shin D, et al. Rheumatoid arthritis and risk of depression in South Korea. JAMA Netw Open. (2024) 7:e241139. 10.1001/jamanetworkopen.2024.1139 - DOI - PMC - PubMed
    1. Russell M, Gibson M, Zuckerman B, Kumar K, Dubey S, Adas M, et al. Factors associated with biological and targeted synthetic disease-modifying antirheumatic drug initiation for rheumatoid arthritis in underserved patient groups in England and Wales, UK: a national cohort study. Lancet Rheumatol. (2025) 7:e44–54. 10.1016/S2665-9913(24)00221-2 - DOI - PubMed

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