title: Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden.
abstract: OBJECTIVE
  To provide Swedish nationwide data on the prevalence of rheumatoid arthritis (RA), including variations by age, sex, geography, demography and education level, and assess antirheumatic treatment penetration.
  
  
  METHODS
  Patients ≥16 years assigned an RA diagnosis were identified from inpatient (n=96 560; 1964-2007) and specialist outpatient care (n=56 336; 2001-2007) in the Swedish National Patient Register, and the Swedish Rheumatology Quality Register (n=21 242; 1995-2007). Data on prescriptions, demography, vital status and educational level were retrieved from national registers.
  
  
  RESULTS
  A total of 58 102 individuals (mean age 66 years; 73% women) assigned an RA diagnosis were alive in Sweden in 2008, corresponding to a cumulative prevalence of 0.77% (women 1.11%, men 0.43%). The 2001-2007 period prevalence was 0.70%. Restriction to patients with ≥2 visits or diagnosis from a rheumatologist/internist reduced the overall cumulative prevalence to 0.68%. Whereas urban/rural differences (crude 0.65-1.00%) were explained by age differences, the age/sex-adjusted prevalence remained higher in patients with ≤9 years education (0.86%) than for those with 10-12 years (0.82%) and >12 years (0.65%). Treatment exposures (76% any disease-modifying antirheumatic drugs (DMARDs) or steroids, 64% any DMARD, 15% biological agents) varied with age; use of biological agents decreased from 22% in 16-59 years olds to 3% in ≥80 years olds. Any DMARD use correspondingly decreased from 71% to 43%. Applying age cut-off points from previous northern European and North American prevalence studies reduced or eliminated between-study differences.
  
  
  CONCLUSIONS
  This nationwide approach yielded a prevalence of RA similar to previous regional assessments. While displaying only modest geographical variation and no urban/rural gradient, prevalence was associated with educational level. Although most patients received antirheumatic drugs, age was a strong treatment determinant.
authors.affiliation: Clinical Epidemiology Unit T2, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden. Martin.Neovius@ki.se
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.forename: Julia F
authors.initials: JF
authors.lastname: Simard
authors.forename: Johan
authors.initials: J
authors.lastname: Askling
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012111:Residence Characteristics; D012423:Rural Health / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors