Arthritis in Canada : An Ongoing Challenge - Chapter 2 The Impact of Arthritis on Canadians - Publications

Arthritis is one of the most prevalent chronic health conditions in Canada and a major cause of morbidity, disability and health care utilization.^1-3 It poses a major economic and health burden to our society. This chapter provides information on arthritis in Canada, and its impact on the population as a whole and on the lives of individuals. The chapter develops a profile of arthritis: who has it; its impact on daily life; and the self-reported use of health services and medications. Chapter 2 also presents data on the Aboriginal community living off-reserve, as arthritis is one of the most prevalent chronic diseases in this population.^4-6 Implications for surveillance activities and health policies are addressed at the end of the chapter.

A description of the data sources used and the methodological aspects employed for this chapter^† is found in the Appendix at the chapter's end. The Appendix includes definitions of variables/indicators used within the chapter along with the methods employed for grouping/categorizing them. The symbol “(m)” on graphs indicates that high sampling variability was associated with the reported estimate. Also, if sub-sample populations (such as age-sex groups) were too small, then no estimate is shown.

Individuals with arthritis will often live with the disease for life. The Canadian Community Health Survey (CCHS) asked respondents about the presence of any chronic conditions. “Arthritis/ rheumatism” was included in a list of health conditions presented in conjunction with the question, “Do you have any of the following long-term conditions that have been diagnosed by a health professional?” Long-term was defined as having lasted or expected to last six months or longer.

In 2000, arthritis and rheumatism affected nearly 4 million Canadians aged 15 years and older, representing 16% of this population. Arthritis was the second and third most common chronic condition reported by women and men respectively (Figure 2-1).

According to the 2000 CCHS, the prevalence of arthritis/rheumatism increased with increasing age. Women aged 35 years and over reported statistically higher rates than men (Figure 2-2). As a result of the influence of Canada's large “baby boomer” generation, most people with arthritis were aged between 45 and 75 years. Two-thirds of those affected with arthritis were women, whose prevalence was almost twice that of men (19% versus 11% respectively).

While arthritis is commonly perceived as a disease of the aged, in reality nearly 3 of 5 people who reported having arthritis/rheumatism in 2000 were younger than 65 years of age (Figure 2-3). This ratio holds for both men and women.

Figure 2-2 Self-reported prevalence and number of individuals with arthritis/rheumatism, by age and sex, household population aged 15 years and over, Canada, 2000

Note: All values for women are significantly higher than values for men at p < 0.05, except for age groups 20-24,25-29, and 30-34.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Figure 2-3 Number of individuals with arthritis/rheumatism, by age and sex,household population aged 15 years and over, Canada, 2000

The crude prevalence of arthritis/rheumatism varied considerably across Canada (Figure 2-4). Residents of Nova Scotia reported most frequently arthritis/rheumatism (23%), followed by Saskatchewan and Prince-Edward Island at nearly 20%. Residents in the Territories reported arthritis/rheumatism the least often (11.6%).

Figure 2-4 also displays the age-sex standardized prevalence estimates in parentheses. These estimates serve to remove the effect of any differences in the age-sex compositions of the respective provinces/territories and permit direct comparison with the overall Canadian prevalence. Standardized prevalence estimates for Nova Scotia, Saskatchewan and Prince Edward Island were significantly higher than the national prevalence, and Quebec's prevalence was significantly lower.

Figure 2-4 Crude (age-sex standardized) prevalence of arthritis/rheumatism,by province/territory, household population aged 15 years and over, Canada, 2000

The prevalence of arthritis/rheumatism increases sharply with age (Figure 2-2). As a result, the overall age structure of the population will have great implications for the prevalence and number of people with arthritis. Population projections from Statistics Canada⁷ for the years 2001 to 2026 provide the means to estimate the number of people with arthritis and the prevalence of arthritis for the next 20 years. Projections are based on the age- and sex-specific arthritis prevalence estimates from the 2000/01 CCHS, with the presumption that they will remain constant over time.

The prevalence of arthritis among Canadians 15 years of age and older is projected to increase by almost 1% every five years, with a projected prevalence of more than 20% by the year 2026 (Table 2-1). This represents an increase of 54% in the number of people with arthritis. It is estimated that within 25 years, 6.4 million Canadians 15 years of age and older will have the disease, the largest increases occurring among adults aged 55 years and older (Figure 2-5).

Figure 2-5 Number of individuals projected to have arthritis/rheumatism, by year and age group, household population aged 15 years and over, Canada, 2001-2026

Data source: Canadian Community Health Survey 2000, Statistics Canada; Population projections 2001-2026, Statistics Canada

Compared with people without arthritis, people living with arthritis/rheumatism were more likely to be widowed/separated/divorced (Table 2-2), and to have lower formal education (Figure 2-6) and lower incomes (Figure 2-7). The differences in marital status were likely due to the fact that people with arthritis were older.

Figure 2-6 Proportion of individuals with and without arthritis/rheumatism with less than secondary school education, by age, household population aged 15 years and over, Canada, 2000

Note: Differences between people with and without arthritis are statistically significant at p < 0.05 except for people aged 65-74 and 75 and over.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Figure 2-7 Proportion of individuals with and without arthritis/rheumatism within the lowest/lower-middle income category, by age, household population aged 15 years and over, Canada, 2000

Note: Differences between people with and without arthritis are statistically significant at p < 0.05 except for people aged 75 and over.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Being overweight (defined as a body mass index [BMI] >= 27 according to the Canadian standards) is a contributing factor to the development of arthritis, particularly arthritis of the knee.⁸ Moreover, people who are overweight are more likely to have a diagnosis of arthritis.⁹ The CCHS calculated BMI only for individuals 64 years of age and under, excluding pregnant women. In all age groups, the proportion of people with arthritis who were overweight exceeded 18% (Figure 2-8), which was consistently and significantly higher than among people without arthritis.

Figure 2-8 Proportion of individuals aged 20 to 64 years who were overweight*, by age, household population, Canada, 2000

Note: Values for people with arthritis are significantly higher than values for people without arthritis at p < 0.05.* BMI >= 27.0
Data source: Canadian Community Health Survey 2000, Statistics Canada

The prolonged course of arthritis may result in extended pain and suffering and reduced quality of life.¹⁰ In comparison to people with other chronic conditions and no chronic conditions, greater proportions of people with arthritis reported having to stay in bed or reduce activities in the two weeks before being surveyed (Figure 2-9). The proportion of people with arthritis reporting 11 to 14 disability days was more than twice that of people with other chronic conditions.

Figure 2-9 Proportion of individuals reporting any disability days in the previous 14 days, household population aged 15 years and over, Canada, 2000

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05.
Data source: Canadian Community Health Survey 2000, Statistics Canada

The proportion of individuals with arthritis who reported experiencing moderate to severe pain was 3 times as high as the proportion of individuals with other chronic conditions. This pattern did not vary markedly with age (Figure 2-10).

Figure 2-10 Proportion of people reporting moderate to severe pain, by age, household population aged 15 years and over, Canada, 2000

The Health Utility Index (HUI) is a generic health measure designed to assess quantitative and qualitative aspects of life.¹¹ It consists of items that describe functional states including, but not limited to, mobility, dexterity, pain and discomfort. A score of less than 0.83 indicates disability. On the basis of this measure, approximately 40% of people with arthritis in the youngest age group had disability, increasing to nearly two-thirds among those aged 75 years and over (Figure 2-11). Of people with other chronic conditions or no chronic condition, the proportions with disability were much lower. The largest differences were observed in the youngest age group, in which the rate of disability for people with arthritis was 2 to 4 times higher than that of people with other or no chronic conditions.

Figure 2-11 Proportion of individuals with an HUI* indicative of disability, by age, household population aged 15 years and over, Canada, 2000

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05.
*HUI= Health Utility Index
Data source: Canadian Community Health Survey 2000, Statistics Canada

The CCHS asked respondents whether their daily activities at home, work, school or other settings were restricted by a long-term physical or mental condition. In all age groups, the largest proportion that reported activity limitations was among individuals with arthritis (Figure 2-12). In the youngest age group, just over half of those with arthritis reported activity limitations. The proportion increased to two-thirds among those aged 75 years and over who were living with arthritis. Their rates were substantially higher than rates among people with either other or no chronic conditions. Overall, the proportion of people with arthritis who reported activity limitations was between 2 and 10 times higher than the proportion among those with other chronic conditions and no chronic conditions.

Figure 2-12 Proportion of individuals reporting activity limitations, by age, household population aged 15 years and over, Canada, 2000

Respondents were asked whether, because of a health condition, they required help in preparing meals, shopping for groceries, doing everyday housework, doing heavy household chores, maintaining personal care or moving about in the house. Overall, the need for help with daily activities increased with increasing age for all comparison groups, with a sharp increase at the age of 75 years (Figure 2-13). In all age groups, the highest proportions of people who required help were those with arthritis, and in this category the proportion increased from 25% in the youngest age group to nearly 70% in the oldest. In comparison, the proportion ranged from less than 10% to slightly over 50% among individuals with other chronic conditions.

Figure 2-13 Proportion of individuals requiring help with daily activities, by age, household population aged 15 years and over, Canada, 2000

An individual's perception and evaluation of his/her health also yields information about the impact of illness and disease. The CCHS asked respondents to rate their health as excellent, very good, good, fair or poor. Overall, the proportion of individuals who reported fair or poor health increased with increasing age and was greatest among people living with arthritis (Figure 2-14).

Figure 2-14 Proportion of individuals who rated their health as fair or poor, by age, household population aged 15 years and over, Canada, 2000

The CCHS also asked respondents to rate their health compared with one year earlier. The proportion of individuals who reported that their health was worse than a year earlier increased with increasing age among all three comparison groups (Figure 2-15). In all age groups, however, the proportion of people with arthritis who reported that their health was worse than one year earlier was significantly greater than the proportion of those with other and no chronic conditions.

Figure 2-15 Proportion of individuals who rated their health as worse than a year earlier, by age, household population aged 15 years and over, Canada, 2000

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%.
Data source: Canadian Community Health Survey 2000, Statistics Canada

While arthritis is commonly associated with pain and fatigue, it can also disrupt sleep.¹² In all age groups, a greater proportion of people with arthritis reported sleeping for less than 6 hours per night (Figure 2-16). The largest difference between people with arthritis and those with other chronic conditions was in the youngest age group (15-44 years): the proportion here was twice as high as among those with other conditions. Until the age of 74 years, the proportion of people with arthritis who reported less than 6 hours of sleep was relatively similar across the age groups.

Figure 2-16 Proportion of people reporting less than 6 hours of sleep per night, by age, household population aged 15 years and over, Canada, 2000

People with arthritis reported the highest rates of sleeping problems “most of the time” (Figure 2-17). There was no significant difference between age groups. A greater proportion of people with arthritis also reported that they did not find sleep refreshing and, as a result, had difficulty staying awake at other times (data not presented).

Figure 2-17 Proportion of individuals reporting sleeping problems most of the time, by age, household population aged 15 years and over, Canada, 2000

The perceived amount of stress experienced on a daily basis can be a consequence of illness or disease. The only significant differences in the level of perceived stress between people with arthritis and individuals with other chronic conditions were in the youngest age group (15-44) and in those aged 65 to 74 (Figure 2-18). The proportion in each of these age groups who reported finding life extremely stressful was nearly twice as high for people with arthritis as it was among those living with other chronic conditions.

Figure 2-18 Proportion of individuals reporting life to be extremely stressful, by age, household population aged 15 years and over, Canada, 2000

Notes: Values for people with arthritis are significantly higher than values for people with other and no chronicconditions at p < 0.05 except for those aged 45-64 and 75 and over.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%.
Because of the small sample size, data for people aged 75+ years in the “no chronic condition” group cannot bereleased.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Figure 2-19 displays the proportions of people with indications of case depression (see Appendix). Overall, the proportions declined with age. They were significantly higher for people with arthritis across all ages, the largest differences being found among those aged 15 to 44.

Figure 2-19 Proportion of individuals with case depression, by age, household population aged 15 years and over, Canada, 2000

Notes: Values for people with arthritis are significantly higher than values for people with other and no chronicconditions at p < 0.05.
Because of the small sample size, data for people aged 75+ years in the “no chronic condition” group cannot bereleased.
Data source: Canadian Community Health Survey 2000, Statistics Canada

According to the CCHS, arthritis also influences an individual's participation in the labour force. Over 1 in 10 individuals of working age reported having arthritis. The proportion of people not working was highest among those with arthritis in comparison to those with other or no chronic conditions. The proportion increased with increasing age, especially after 55 years (Figure 2-20). Early retirement, as well as departures from the labour force due to ill health, likely accounted for some of this increase.

Figure 2-20 Proportion of individuals not in the labour force, by age, household population aged 25 years and over, Canada, 2000

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05 except for those aged 15-44 years old.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Being physically active has the potential to prevent arthritis and ease the pain associated with the disease.^13,14 For many individuals, physical activity is also an important component of recreational activities. According to the CCHS, a very high proportion of Canadians were physically inactive in 2000 (Figure 2-21). Among people with arthritis, over 50% in all age groups were physically inactive - a proportion higher than among individuals with either no or other chronic conditions.

Figure 2-21 Proportion of individuals who reported being physically inactive, by age, household population aged 15 years and over, Canada, 2000

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05 except for those aged 45 to 64 years old.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Access to health care services is vital to the management of arthritis and other chronic conditions. A higher proportion of people with arthritis compared with those with other chronic conditions reported that they had used health care services in the previous year. Specifically, they sought the services of a primary care physician, a specialist (including surgeons, allergists, orthopedists, and psychiatrists), a nurse, a physiotherapist, other health care provider or an alternative care provider (including massage therapists, chiropractors and acupuncturists).

Over half of people with arthritis had consulted primary care physicians (general practitioners or family physicians) at least four times in the previous year, compared with 33% of people with other chronic conditions. Similarly, 43% of people with arthritis reported seeing a specialist at least once, compared with 33% and 16% of individuals with other chronic conditions or no chronic conditions respectively. Compared with those with other chronic conditions, a higher proportion of both men and women with arthritis consulted either a primary care physician or a specialist. This pattern was consistent in every age group (Figures 2-22 and 2-23). Overall, women reported greater use of physicians' and specialists' services than men (data not shown).

Figure 2-22 Proportion of individuals who consulted a primary care physician at least four times in previous year, by age, household population aged 15 years and over, Canada, 2000

Figure 2-23 Proportion of individuals who consulted a specialist at least once in the previous year, by age, household population aged 15 years and over, Canada, 2000

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05 except for those aged 75 and over.
Data source: Canadian Community Health Survey 2000, Statistics Canada

The proportion of people with arthritis who visited primary care physicians and specialists varied by province/territory. In all provinces/territories, the proportion of individuals with arthritis who reported seeing either a primary care physician at least four times or a medical specialist at least once in the previous year was greater than the corresponding proportions of people with either other or no chronic conditions (data not shown). The greatest proportion of people with arthritis who visited their general practitioner or family physician (GP/FP) at least four times in the previous year was in Newfoundland (61%), followed closely by Nova Scotia, British Columbia and Saskatchewan (Figure 2-24). The lowest proportion was found in Quebec (40%).

The proportion of people with arthritis who visited a medical specialist did not vary as much as the proportion who visited a GP/FP. However, the greatest proportion of people with arthritis who visited a medical specialist was in Quebec, at just under 50%, followed by Ontario and New Brunswick (Figure 2-24). The lowest proportion was found in Prince Edward Island (35%).

Figure 2-24 Proportion of individuals with arthritis who consulted a primary care physician* or a specialist**, by province/territory, household population aged 15 years and over, Canada, 2000

*at least 4 visits in the previous year
**at least 1 visit in the previous year
Data source: Canadian Community Health Survey 2000, Statistics Canada

In 2000, only 13% of people with arthritis reported seeing a nurse for care or advice about their physical, emotional or mental health; 16% saw a physiotherapist (Table 2-3). Compared with people with other chronic conditions, a greater proportion of people with arthritis in all age groups reported consulting either a nurse or physiotherapist. Overall, patterns of use of chiropractic services and consultations with psychologists, social workers and counsellors were similar among people with arthritis and those with other chronic conditions (Table 2-3). The proportions of individuals with arthritis making such consultations were nearly double those of people with no chronic conditions. The proportion of people with arthritis who consulted alternative care providers in the previous year was not significantly different from that of individuals living with other chronic conditions. Massage therapists were the most common type of alternative care provider consulted, followed by acupuncturists (data not shown). Age patterns were similar among individuals with arthritis and those with other chronic conditions who consulted alternative care providers.

In all age groups, the proportion of people who felt that they had not received the health care they needed during the previous 12 months was greatest for people with arthritis compared with people with other and no chronic conditions (Figure 2-25). Overall, 18% of people with arthritis reported that they did not receive health care when needed: 10% reported that care was either unavailable in their area, unavailable when required or required too long a wait. The comparable proportion for people with other chronic conditions was only 7%. The highest proportion of individuals who reported these limitations in access was among those between 15 and 44 years of age - indeed, nearly one-third of the people with arthritis in this age group reported that they had not received necessary care.

Figure 2-25 Proportion of individuals who indicated that they required but did not receive health care in the previous year, by age, household population aged 15 years and over, Canada, 2000

According to the 1998/1999 National Population Health Survey (NPHS), approximately 80% of individuals with arthritis in all age groups reported taking pain relievers such as acetaminophen (including arthritis medicine and anti-inflammatories) in the previous month (Figure 2-26). In all age groups, the proportion who took pain relievers was higher in individuals with arthritis than those with other chronic conditions. This was also the case for reported narcotic pain medication or antidepressants taken in the previous month, and the highest use was in the youngest age group (15-44) (Figures 2-27, 2-28).

Figure 2-26 Proportion of individuals who had taken pain relievers (including arthritis medicine and anti-inflammatories) in the previous month, by age, household population aged 15 years and over, Canada,
1998/99

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05.
Data source: National Population Health Survey 1998/99, Statistics Canada

Figure 2-27 Proportion of individuals who had taken narcotic pain medication in the previous month, by age, household population aged 15 years and over, Canada, 1998/99

Notes: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%. Because of the small sample size, data for the “no chronic condition” group cannot be released.
Data source: National Population Health Survey 1998/99, Statistics Canada

Figure 2-28 Proportion of individuals who had taken antidepressants in the previous month, by age, household population aged 15 years and over, Canada, 1998/99

Note: Values for people with arthritis are significantly higher than values for people with other and no chronic conditions at p < 0.05 except for those aged 65 and over.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%. Because of the small sample size, data for “no chronic condition” group cannot be released.
Data source: National Population Health Survey 1998/99, Statistics Canada

In 2001, Aboriginal peoples (including First Nations, Inuit and Métis) accounted for approximately 3% of the total Canadian population. The Aboriginal population is much younger than the general population. According to the 2001 Census, one-third were less than 15 years of age, and approximately 4% were over the age of 65 years.¹⁵ Geographically, Aboriginal people were disproportionately located in the northern, western and rural parts of the country. About 29% lived on a reserve/settlement. Slightly more than half (51%) lived in an urban area, either a Census Metropolitan Area (CMA) or a non-CMA urban area (29% and 22% respectively). The remainder (49%) resided in a rural area.¹⁵

Aboriginal people are undergoing a health transition marked by an increasing burden of chronic diseases and injuries.^16,17 They tend to bear a disproportionate burden of illness, an outcome that has been linked to their economic and social conditions.^18,19 Only limited data are available on Canada's Aboriginal peoples, and few studies have compared them with the non-Aboriginal population.^4-6 Moreover, Canadian Aboriginal people reported arthritis as one of the five most important health problems in their communities.⁶

Prevalence of Arthritis among Aboriginal People Living Off-reserve and Non-Aboriginal people

Crude prevalence estimates (not adjusted for differing age distributions) of arthritis among Aboriginal and non-Aboriginal people are 19% and 16% respectively (data not shown). When age-standardized, the prevalence of arthritis in the Aboriginal population was 27%, as compared with 16% in the non-Aboriginal population, and arthritis was the most prevalent chronic condition in the Aboriginal population (Figure 2-29).

As with the non-Aboriginal population, the prevalence of arthritis in the Aboriginal population increased with increasing age, with estimates higher among females than males in every age group (Figure 2-30).

Figure 2-29 Standardized prevalence rates of specific chronic conditions among Aboriginal people living off-reserve and non-Aboriginal people aged 15 years and over, household population, Canada, 2000

Note: Differences between Aboriginals and non-Aboriginals are statistically significant at p < 0.05 except for allergy and high blood pressure.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Figure 2-30 Self-reported prevalence of arthritis among Aboriginal people living off-reserve and non-Aboriginals, by age and sex, household population aged 15 years and over, Canada, 2000

Note: Differences between Aboriginals living off-reserve and non-Aboriginals are statistically significant at p < 0.05 for females of all age groups and for males aged 35 to 44.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%.
Data source: Canadian Community Health Survey 2000, Statistics Canada

Quality Of Life Of Aboriginal People with Arthritis Living Off-Reserve and Non-Aboriginal People with Arthritis

Based on the Health Utility Index (HUI) (see Glossary), Aboriginal people with arthritis had higher rates of disability than non-Aboriginals with arthritis. Rates in the Aboriginal population living off-reserve decreased with increasing age up to the age of 65 years and over, when rates became similar to those of the non-Aboriginal population (Figure 2-31).

Figure 2-31 Proportion of individuals with arthritis who reported an HUI* score indicative of disability, by age, Aboriginal people living off-reserve and non-Aboriginal people, household population aged 15 years and over, Canada, 2000

Note: Differences between Aboriginals living off-reserve and non-Aboriginals are statistically significant at p < 0.05 except for people aged 65 years and over.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%.
*HUI = Health Utility Index
Data source: Canadian Community Health Survey 2000, Statistics Canada

In all age groups, compared with non-Aboriginals with arthritis, a larger proportion of Aboriginal people with arthritis living off-reserve reported that they needed to limit either the kind or amount of their activities at home, at work, at school or in their leisure time. The largest differences between the two populations were found in the youngest age group, in which more than 65% of young Aboriginal people with arthritis reported the need to limit their activities compared with 53% of non-Aboriginals (Figure 2-32).

Figure 2-32 Proportion of individuals with arthritis reporting activity limitations, by age, Aboriginal people living off-reserve and non-Aboriginal people, household population aged 15 years and over, Canada, 2000

Note: Differences between Aboriginals living off-reserve and non-Aboriginals are statistically significant at p < 0.05 except for people aged 65 years and over.
(m) indicates that the coefficient of variation is between 16.6% and 33.3%.
Data source: Canadian Community Health Survey 2000, Statistics Canada

This chapter confirms that arthritis is a major cause of morbidity, disability and health care utilization in Canada. In 2000, 16% of Canadians (nearly 4 million) aged 15 years and over reported arthritis as a long-term health condition. It ranked second and third among the most commonly reported chronic conditions in women and men respectively. Arthritis affected twice as many women as men. Of those with arthritis, 60% were of working age (< 65 years old). With the aging of the “baby boomer” population, by 2026 the number of Canadians with arthritis/rheumatism is expected to increase to more than 6 million, or 1 in 5 Canadians. Individuals 55 years of age and older will account for most of this increase.

Compared with people with other chronic conditions, greater proportions of people with arthritis reported having low income, and they were more likely to be overweight. People with arthritis in all age groups consistently rated their health as worse than did people with other chronic diseases. Across all age groups, a greater proportion of people with arthritis reported recent days of reduced activity because of ill health, severe pain and activity limitation; the need for help with daily activities; and problems with sleep. They were also more likely to report their overall health as only fair or poor, and worse than a year earlier. More individuals with arthritis tended to be out of the labour force and physically inactive. They were also more likely than people with other chronic conditions to have visited a primary care physician at least four times in the previous year and to have seen a specialist or physical therapist.

Although these findings cannot be directly attributed to arthritis, they may indicate the differential impact that arthritis has over and above other chronic conditions. Although the category “other chronic conditions” includes conditions such as allergies, which are generally perceived as less serious, it should be noted that people with arthritis also present with other chronic conditions (co-morbidities), which can include allergies.

Although the prevalence of arthritis increased with age, its impact in terms of pain and activity limitation was much the same in all age groups. The health gap between people with arthritis and individuals with other chronic diseases was widest in the younger age groups, and this gap narrowed with increasing age. These differences among younger individuals highlight the impact of arthritis on young Canadians. The narrowing of the health gap with increasing age may be associated with the increasing number of health problems among older individuals in general.

A greater proportion of Aboriginal people living off-reserve than non-Aboriginals reported that they had arthritis (19% versus 16%). However, if the off-reserve Aboriginal population had the same age composition as the overall Canadian population, it was estimated that the prevalence of arthritis in the off-reserve Aboriginal population would be 26.5%. A greater proportion of the off-reserve Aboriginal population with arthritis reported activity limitations and disability (as measured by the HUI) compared with their non-Aboriginal counterparts. The extent to which this is directly attributable to arthritis or to other chronic conditions that are also more frequently reported by the Aboriginal population is unclear. It may be a result of a higher prevalence of specific types of arthritis, such as rheumatoid arthritis and ankylosing spondylitis, among Aboriginal people.^5,6

Since data from the CCHS are cross-sectional, temporal or causal relationships among the different indicators presented in this chapter cannot be assumed.

The prevalence of arthritis in Canada currently stands at 16%. On the basis of current projections, 1 million more Canadians will have arthritis within 10 years. In 20 years, the prevalence may reach 1 in 5 Canadians. In the past, Canadian population-based research on the burden of arthritis has been minimal, leaving the public health implications of the condition inadequately understood. Individuals with arthritis tend to make contact with health care service providers in greater proportions than people with other chronic health conditions. The implications are an increased economic burden placed on the health care system and increased need for health care providers who can offer adequate services to this growing population

Currently, Canada has limited surveillance activities related to arthritis. Arthritis in Canada represents the first publication on arthritis that focuses on the national level. However, Chapter 2 provides a snapshot of the burden of this disease. Monitoring the disease over time would permit the examination of changes in prevalence and incidence, and of the effectiveness of public health and other interventions.

The incidence, severity, processes of care and outcomes associated with arthritis differ among racial or ethnic groups.²⁰ The reasons for these disparities are largely unknown. Surveillance activities for arthritis and related conditions should include the Aboriginal population living on-reserve as well as populations of other ethnic background. Given the increasing ethnic diversity of the Canadian population and the aging of the immigrant population, differences in the experience of arthritis among people in different ethnic groups are likely to become of even greater concern in the future.

While the prevalence of self-reported arthritis/rheumatism is substantial in Canada, it is believed that the prevalence reported here underestimates, in fact, the true prevalence. The CCHS asked respondents about arthritis and rheumatism “diagnosed by a health professional”. This question fails to capture many people with arthritis/chronic joint symptoms who do not see a physician for their symptoms and whose condition remains undiagnosed. Therefore, the inclusion of a question on “chronic joint symptoms” would help in providing a more complete picture of the burden of arthritis in Canada.

More detailed diagnostic questions for arthritis, such as those currently used in the Behavioral Risk Factor Surveillance System (BRFSS) surveys in the United States, could be included in future national surveys. Consideration could also be given to including physical measures of arthritis, such as assessment of physical function in the general population, as part of future surveys.

Current population surveys lack questions with sufficient detail either to enable differentiation between types of arthritis or to describe the nature of activity limitations. As a result, the impact of arthritis on mobility, independence, work, and leisure and family activities remains largely unknown. More data on these issues would not only help to document the economic and social consequences of arthritis for the Canadian population but would also provide a sound basis for assessing the need for other interventions. Accurately describing the impact of arthritis will require data that are directly attributable to the condition. This also applies to data on health care utilization. The Participation and Activity Limitations Survey (PALS) 2001 will provide detailed data that will better describe the nature of activity limitations of people living with arthritis.

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12. Jordan JM, Bernard SL, Callahan LF, Kincade JE, Konrad TR, DeFriese GH. Self-reported arthritis-related disruptions in sleep and daily life and the use of medical, complementary, and self-care strategies for arthritis: The National Survey of Self-care and Aging. Arch Family Med 2000;9:143-9.

13. Centers for Disease Control and Prevention. National Arthritis Action Plan: a public health strategy. Atlanta: Georgia, 1999.

14. Centre for Disease Prevention and Control. Prevalence and impact of arthritis by race and ethnicity - United States, 1989-1991. MMWR 1996;45(18):373-9.

15. Statistics Canada. Aboriginal peoples of Canada: a demographic profile. Ottawa: Statistics Canada, 2001. Catalogue no. 96F0030XIE2001007

16. Wilson K, Rosenberg M. Exploring the determinants of health for First Nations peoples in Canada: Can existing frameworks accommodate traditional activities? Soc Sci Med 2002;55(11):2017-31.

17. First Nations and Inuit Regional Health Survey National Steering Committee. First Nations and Inuit Regional Health Survey. Ottawa: First Nations and Inuit Health Branch, Health Canada; 1997.

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20. Jordan JM, Lawrence R, Kington R, Fraser P, Karlson E, Lorig K, et al. Ethnic health disparities in arthritis and musculoskeletal diseases. Report of a scientific conference. Arthritis & Rheum 2002;46(9):2280-6.

* In Chapter 2, the term “arthritis” refers to arthritis/rheumatism, in keeping with the survey question on the Canadian Community Health Survey (CCHS), 2000.

† The analysis is based on the Statistics Canada microdata tape Canadian Community Health Survey, 2000. All computations on these microdata were done by Health Canada, and the responsibility for the use and interpretation of these data is entirely that of the author(s).


	Last Updated: 2003-10-17		Important Notices

Chapter 2 The Impact of Arthritis* on Canadians

Chapter 2
The Impact of Arthritis^* on Canadians