Epidemiology of Rheumatoid Arthritis (RA) in rural and urban areas of Poland - 2008-2012.
OBJECTIVE
The aim of this study is to investigate the morbidity rate due to Rheumatoid Arthritis (RA) in the Polish population during 2008-2012, calculated per 1,000 inhabitants, and taking into account the differences between provincess, area of residence (urban or rural) and gender.


METHODS
From the NFZ IT systems, PESEL number information was obtained for all 17 types of services contracted in 2008-2012, for patients whose main diagnosis in the report was the ICD-10 disease code: M05.X - seropositive rheumatoid arthritis, or M06.X - other rheumatoid arthritis. The number of patients, gender and age were calculated based on the PESEL number provided in the statistical reports of the patient with the analysed ICD-10 diagnosis. Urban and rural cases were compared using commune zip codes. The basis for classifying the patient as a member of an urban or rural population was the Zip Code of the declared place of residence. Urban and rural areas are classified based on administrative criteria provided by the Central Statistical Office: the National Official Register of Territorial Division of the Country (TERYT).


RESULTS
During the studied period the number of RA patients increased from 173,844-230,892. In urban areas, the most patients were recorded in the Śląskie Province, the least in Lubuskie Province. Patients from rural areas were approx. 1/3(rd) of the total population of patients in Poland. In rural areas, the most patients were recorded in the Mazowieckie Province, the least in Lubuskie Province. The morbidity rate in cities was 5.08 in 2008 and increased to 8.14 in 2012 in rural areas, respectively, it was 3.74 and increased to 3.98. Regardless of the place of residence the women fell ill 3.5 times more frequently. The lowest morbidity rate, both in rural and urban areas, was recorded in the Lubuskie Province, the largest in Świętokrzyskie Province. The the most probable explanation of the highest morbidity rate in the latter province is a worse access to a rheumatologist: in this province there is the lowest number of inhabitants per one employed rheumatologist.


CONCLUSIONS
In Poland, the number of RA sufferers is increasing, which is probably a result of increasing life expectancy. In Poland, also exists a differences in morbidity between urban and rural inhabitants. Differences may also derive from undiagnosed cases of the disease.
Health Care Policy Department, Medical University, Łódź, Poland.
Petre
P
Iltchev
Public Health Department, Health Sciences Faculty, Medical University, Łódź, Poland; National Health Fund (NFZ), Warsaw, Poland.
Andrzej
A
Śliwczyński
National Health Fund (NFZ), Warsaw, Poland.
Tomasz
T
Czeleko
K. Jonscher Hospital, Łódź, Poland.
Aleksandra
A
Sierocka
Military Medical Institute, Warsaw, Poland.
Małgorzata
M
Tłustochowicz
Military Medical Institute, Warsaw, Poland.
Witold
W
Tłustochowicz
Emergency Medicine and Disaster Medicine Institute, Medical University, Łódź, Poland.
Dariusz
D
Timler
National Health Fund (NFZ), Warsaw, Poland.
Melania
M
Brzozowska
Hygiene and Epidemiology Department, Medical University, Łódź, Poland.
Franciszek
F
Szatko
Health Care Policy Department, Medical University, Łódź, Poland.
Michał
M
Marczak
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011044:Poland / Q000453:epidemiology; D012423:Rural Health / Q000706:statistics & numerical data*; D014504:Urban Health / Q000706:statistics & numerical data*