Disease burden and future trends of rheumatoid arthritis in mainland China from 1990 to 2021_Chinese Journal of Evidence-Based Medicine

Authors：

HU Rui ¹ , WANG Mei ¹ , REN Shuang ² , MENG Fanyan ² , WANG Zhidan ¹ , ZHANG Xiaoyu ² ,  ZHANG Jie ²

1. Liaoning University of Traditional Chinese Medicine, Shenyang 110847, P. R. China;
2. The First Affiliated Hospital of China Medical University, Shenyang 110001, P. R. China;

Corresponding author：

ZHANG Jie, Email: zhangjie945@126.com

Keywords：

Rheumatoid arthritis; Incidence; Prevalence; Disability adjusted life years; Disease burden

DOI：

10.7507/1672-2531.202504171

Video：

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Objective To analyze the trends and influencing factors of rheumatoid arthritis disease burden in mainland China from 1990 to 2021 and predict its disease burden over the next 15 years. Methods Data on RA incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in mainland China were extracted from the Global Burden of Disease Study 2021 (GBD 2021). Joinpoint regression was used to analyze temporal trends, while an age-period-cohort model assessed age, period, and birth cohort effects. Decomposition analysis explored the contributions of population aging, population growth, and epidemiological changes. An ARIMA model was applied to predict future disease burden. Results From 1990 to 2021, the number of RA cases in mainland China increased by 93.5% (incidence), 133% (prevalence), 115% (deaths), and 107% (DALYs), though age-standardized rates showed smaller changes. The disease burden was significantly higher in women than in men, with sex-specific peaks in onset and prevalence. Joinpoint regression revealed rising age-standardized incidence and prevalence rates (AAPC=0.54% and 0.51%, respectively) but declining mortality (AAPC=−0.78%). Cohort effects indicated higher RA risk in later-born populations (RR=1.53 for the 2012 cohort). Decomposition analysis identified population growth as the primary driver of increased burden. Projections suggested that by 2036, the age-standardized incidence and prevalence would rise to 13.92/100 000 and 248.84/100 000, respectively, while DALYs rates might decline to 42.09/100 000. Conclusion The RA disease burden in mainland China is driven by both population aging and epidemiological factors, with notable sex disparities and cohort effects. Targeted interventions for high-risk populations, optimized healthcare resource allocation, and further research on influencing factors are needed to develop precise prevention and control strategies.

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30.	Xie W, Li J, Zhang X, et al. Trends in the activity of rheumatoid arthritis as the consequence of treat-to-target strategy: eight-year data from 2009 to 2016. Clin Exp Rheumatol, 2018, 36(5): 820-828.

1. Deane KD, Holers VM. Rheumatoid arthritis pathogenesis, prediction, and prevention: an emerging paradigm shift. Arthritis Rheumatol, 2021, 73(2): 181-193.
2. 姜楠, 田新平, 曾小峰. 《2024中国类风湿关节炎诊疗指南》解读. 协和医学杂志, 2025, 16(1): 28-34.
3. Xie W, Yang X, Zhang Z. The plight and light of treating rheumatoid arthritis in China. Lancet Rheumatol, 2019, 1(2): e81-e82.
4. Jin S, Li M, Fang Y, et al. Chinese registry of rheumatoid arthritis (CREDIT): II. prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis. Arthritis Res Ther, 2017, 19(1): 251.
5. Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021, 398(10294): 53-63.
6. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
7. 张偲莹, 高宗石, 吴丽宏, 等. 中国1990—2019年儿童青少年哮喘疾病负担变化趋势. 中国学校卫生, 2022, 43(1): 123-128.
8. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2100-2132.
9. Sun P, Yu C, Yin L, et al. Global, regional, and national burden of female cancers in women of child-bearing age, 1990-2021: analysis of data from the global burden of disease study 2021. EClinicalMedicine, 2024, 74: 102713.
10. GBD 2021 Lower Respiratory Infections and Antimicrobial Resistance Collaborators. Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Infect Dis, 2024, 24(9): 974-1002.
11. GBD 2021 Nervous System Disorders Collaborators. Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol, 2024, 23(4): 344-381.
12. 于洗河, 曹鹏, 贾欢欢, 等. 1990—2019年我国及不同SDI水平国家和地区高血压性心脏病疾病负担比较分析. 中国卫生经济, 2021, 40(6): 54-57.
13. Zhang Y, Liu J, Han X, et al. Long-term trends in the burden of inflammatory bowel disease in China over three decades: a joinpoint regression and age-period-cohort analysis based on GBD 2019. Front Public Health, 2022, 10: 994619.
14. 白金姝, 秦丽岩, 史光忠, 等. 1990—2019年中国利什曼病发病趋势及年龄-时期-队列模型分析. 热带病与寄生虫学, 2024, 22(2): 76-82.
15. 赵晓晓, 卢笑晖, 柯立鑫, 等. 1990—2021年全球与中国老年人群高血压疾病负担分析及未来趋势预测. 协和医学杂志, 2025, 16(3): 647-658.
16. Jian Y, Zhu D, Zhou D, et al. ARIMA model for predicting chronic kidney disease and estimating its economic burden in China. BMC Public Health, 2022, 22(1): 2456.
17. 邹小江, 赵寒, 王祈茵, 等. 基于ARIMA模型的重庆市流行性感冒预测研究. 重庆医科大学学报, 2023, 48(12): 1425-1429.
18. Alpízar-Rodríguez D, Pluchino N, Canny G, et al. The role of female hormonal factors in the development of rheumatoid arthritis. Rheumatology (Oxford), 2017, 56(8): 1254-1263.
19. Safiri S, Kolahi AA, Hoy D, et al. Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis, 2019, 78(11): 1463-1471.
20. Zhao SS, Holmes MV, Zheng J, et al. The impact of education inequality on rheumatoid arthritis risk is mediated by smoking and body mass index: Mendelian randomization study. Rheumatology (Oxford), 2022, 61(5): 2167-2175.
21. Qian Y, Zhang L, Wu DJH, et al. Genetic predisposition to smoking is associated with risk of rheumatoid arthritis: a Mendelian randomization study. Arthritis Res Ther, 2020, 22(1): 44.
22. Wang M, Luo X, Xu S, et al. Trends in smoking prevalence and implication for chronic diseases in China: serial national cross-sectional surveys from 2003 to 2013. Lancet Respir Med, 2019, 7(1): 35-45.
23. Li Y, Zhu Y, Tang X, et al. Association of visceral fat metabolism score with risk of rheumatoid arthritis in US adults. Front Nutr, 2025, 12: 1544624.
24. Corrado A, Guadagni I, Picarelli G, et al. Obesity and chronic inflammation: implications for rheumatoid arthritis, spondyloarthritis, and ulcerative colitis. Immun Inflamm Dis, 2025, 13(1): e70080.
25. Di D, Zhang L, Wu X, et al. Long-term exposure to outdoor air pollution and the risk of development of rheumatoid arthritis: a systematic review and meta-analysis. Semin arthritis rheum, 2020, 50(2): 266-275.
26. Zeng P, Chen Z, Klareskog L, et al. Amount of smoking, duration of smoking cessation and their interaction with silica exposure in the risk of rheumatoid arthritis among males: results from the Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study. Ann Rheum Dis, 2018, 77(8): 1238-1241.
27. Wrangel O, Graff P, Bryngelsson IL, et al. Silica dust exposure increases risk for rheumatoid arthritis: a Swedish national registry case-control study. J Occup Environ Med, 2021, 63(11): 951-955.
28. Mehri F, Jenabi E, Bashirian S, et al. The association between occupational exposure to silica and risk of developing rheumatoid arthritis: a meta-analysis. Saf Health Work, 2020, 11(2): 136-142.
29. Tian X, Li M, Zeng X. The current status and challenges in the diagnosis and treatment of rheumatoid arthritis in China: an annual report of 2019. Rheumatol Immunol Res, 2021, 2(1): 49-56.
30. Xie W, Li J, Zhang X, et al. Trends in the activity of rheumatoid arthritis as the consequence of treat-to-target strategy: eight-year data from 2009 to 2016. Clin Exp Rheumatol, 2018, 36(5): 820-828.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesDisease burden and future trends of rheumatoid arthritis in mainland China from 1990 to 2021

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