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Home : Publications: Arthritis in Canada - An Ongoing Challenge

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Table of Contents

Chapter 3
Methodological Appendix  

Table 3A-1    Arthritis and gastrointestinal bleeding mortality codes 

Disease Group 

ICD-9 Codes 

Connective Tissue Diseases 

446, 710 

Rheumatoid Arthritis 

714 

Osteoarthritis and Allied Disorders 

715 

Other Arthritis 

098.5, 099.3, 274, 696, 711-713, 716-721 

Rheumatism 

725-729 

Arthritis and Related Conditions 

All of the above 

Gastrointestinal Bleeding 

531-531.6, 532-532.6 , 533-533.6, 534-534.6, 535.0, 578.0, 578.1, 578.9 

Table 3A-2    Methods for calculating life expectancy and health-adjusted life expectancy (HALE) for people with arthritis 

Variable Definition 

The Health Utilities Index 

The Health Utilities Index (HUI3) was used to calculate health-adjusted life expectancy (HALE).28 The HUI3 is a utility-based, multi-attribute health classification system that estimates a summary value of individual health where 0.0 = “dead” and 1.0 = “perfect health” (states worse than death are also possible), based on preference scores for different health states.29 Each respondent in the CCHS 2000/01 answered questions pertaining to eight attributes of functional health: vision, hearing, speech, mobility, dexterity, emotional state, cognition and level of pain and discomfort. Each attribute has from 5 to 6 possible levels, ranging from unrestricted to a highly disabled state (see Torrance et al.30 for a description of health states). The eight attributes were then combined using preference scores from the HUI mark III version and the following multi-attribute utility function:31 

u = 1.371 (u1 * u2 * u3 * u4 * u5 * u6 * u7 * u8) - 0.371 

Analysis Methods 

Arthritis-deleted Mortality Rate and HUI3 Estimates 

Arthritis-deleted mortality rates and HUI3 estimates were calculated by subtracting the mortality rate for people with arthritis from the overall mortality rate for each age-sex group. Arthritis mortality for 1994-98 was used to reduce the variability of age-specific mortality rates. Arthritis-deleted HUI3 was calculated in a similar manner by removing all people with arthritis from the CCHS sample and recalculating the mean HUI3 for each age-sex group. 

Life Table Analysis 

Period life tables for 1996-98 for men and women were calculated using an adaptation of Chiang's method32 and 20 standard age groups (< 1,1-4, 5-9,…, 90+ years), except for an adaptation for the final age group.33 Arthritis-deleted life expectancy was calculated by substituting the arthritis-deleted mortality rates for the overall mortality rates in the life table.34 

HALE was calculated using a modified Sullivan method.35 Sullivan used a period life table and the prevalence of disability to estimate the number of life years lived free of disability. After calculation
of life tables for each group, HALE was estimated by weighting the years of life lived according to the mean HUI3 values by age and sex for each population. The arthritis-deleted mean HUI3 values were used to calculate arthritis-deleted HALE. 

References 

1.    Callahan LF, Pincus T. Mortality in the rheumatic diseases. Arthritis Care Res 1995;8(4):229-41. 

2.    Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA, et al. The mortality of rheumatoid arthritis. Arthritis Rheum 1994;37(4):481-94. 

3.    Doran MF, Pond GR, Crowson CS, O'Fallon WM, Gabriel SE. Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period. Arthritis Rheum 2002;46(3):625-31. 

4.    Wong JB, Ramey DR, Singh G. Long-term morbidity, mortality, and economics of rheumatoid arthritis.
Arthritis Rheum 2001;44(12):2746-9. 

5.    Monson RR, Hall AP. Mortality among arthritics. J Chron Dis 1976;29:459-67. 

6.    Vandenbroucke JP, Hazevoet HM, Cats A. Survival and cause of death in rheumatoid arthritis: a 25-year prospective follow-up. J Rheumatol 1984;11(2):158-61. 

7.    Mutru O, Laakso M, Isomaki H, Koota K. Ten year mortality and causes of death in patients with rheumatoid arthritis. Br Med J (Clin Res Ed) 1985;290(6484):1797-9. 

8.    Myllykangas-Luosujarvi RA, Aho K, Isomaki HA. Mortality in rheumatoid arthritis. Sem Arthritis Rheum 1995;25(3):193-202. 

9.    Nurmohamed MT, van Halm VP, Dijkmans BA. Cardiovascular risk profile of antirheumatic agents in
patients with osteoarthritis and rheumatoid arthritis. Drugs 2002;62(11):1599-609. 

10.    Brandt KD. The role of analgesics in the management of osteoarthritis pain. Am J Ther 2000;7(2):75-90. 

11.    Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 2000;27(2):269-81. 

12.    Singh G, Triadafilopoulos G. Epidemiology of NSAID induced gastrointestinal complications. J Rheumatol 1999;26(Suppl 56):18-24. 

13.    Goldstein JL. Who needs prophylaxis of nonsteroidal anti-inflammatory drug-induced ulcers and what is optimal prophylaxis? Eur J Gastroenterol Hepatol 2000;12(Suppl 1):S11-S15. 

14.    Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs.
N Engl J Med 1999;340:984-91. 

15.    Singh G, Ramey DR, Morfeld D. Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study. Arch Intern Med 1996;156:1530-6. 

16.    Bélanger A, Martel L, Berthelot, JM., Wilkins R. Gender differences in disability-free life expectancy for
selected risk factors and chronic conditions in Canada. J Women Aging 2000;14(1/2):61-83. 

17.    Manuel DG, Schultz SE, Kopec JA. Measuring the health burden of chronic disease and injury using health adjusted life expectancy and the Health Utilities Index. J Epidemiol Community Health 2002;56:843-50. 

18.    Crimmins EM, Kim JK, Hagedorn A. Life with and without disease: Women experience more of both.
J Women Aging 2002;14(1/2):47-59. 

19.    Health Canada. Economic Burden of Illness in Canada, 1998. Ottawa: Public Works and Government Services Canada, 2002. (Catalogue # H21-136/1998E) 

20.    Wigle DT, Mao Y, Wong T, Lane R. Economic burden of illness in Canada, 1986. Chron Dis Can 1991;12(Suppl 3). 

21.    Moore R, Mao Y, Zhang J, Clarke K. Economic Burden of Illness in Canada, 1993. Ottawa: Canadian Public Health Association, 1997. 

22.    Vandenbroucke JP, Hazevoet HM, Cats A. Survival and cause of death in rheumatoid arthritis: a 25-year prospective follow up. J Rheumatol 1984;11(2):158-61. 

23.    Mutru O, Laakso M, Isomaki H, Koota K. Ten year mortality and causes of death in patients with rheumatoid arthritis. Br Med J (Clin Res Ed) 1985;290(6484):1797-9. 

24.    Myllykangas-Luosujarvi RA, Aho K, Isomaki HA. Mortality in rheumatoid arthritis. Sem Arthritis Rheum 1995;25(3):193-202. 

25.    Nurmohamed MT, van Halm VP, Dijkmans BA. Cardiovascular risk profile of antirheumatic agents in patients with osteoarthritis and rheumatoid arthritis. Drugs 2002;62(11):1599-609. 

26.    Brandt KD. The role of analgesics in the management of osteoarthritis pain. Am J Ther 2000;7(2):75-90. 

27.    Coyte P, Asche C, Croxford R, Chan B. The economic cost of arthritis and rheumatism in Canada.
In: Williams JI, Badley EM, editors. Patterns of Health Care in Ontario: Arthritis and Related Conditions. Toronto: Institute for Clinical Evaluative Sciences, 1998; 11-26. 

28.    Feeny D, Torrance G, Furlong W. Health utilities index. In: Spilder B, editor. Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia: Lippincott-Raven, 1996; chapter 26. 

29.    Feeny D, Furlong W, Boyle M, Torrance GW. Multi-attribute health status classification systems. Health Utilities Index. Pharmacoeconomics 1995;7(6):490-502. 

30.    Torrance G, Furlong W, Feeny D, Boyle M. Multi-attribute preference functions - Health Utilities Index. Pharmacoeconomics 1995;7(6):503-20. 

31.    Furlong W, Feeny D, Torrance G, Barr R. The Health Utilities Index (HUI) System for Assessing Health- Related Quality of Life in Clinical Studies. #01-02. 2001. Health Economics and Policy Analysis Research Working Paper. 

32.    Chiang CL. The Life Table and Its Applications. Malabar, Florida: Robert E. Krieger Publ. Co., 1984. 

33.    Hsieh J. A general theory of life table construction and a precise abridged life table method. Biomed J 1991;2:143-62. 

34.    Newman SC. Formulae for cause-deleted life tables. Stat Med 1987;6(4):527-8. 

35.    Sullivan DF. A single index of mortality and morbidity. HSMHA Health Reports 1971;86(4):347-54. 

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