A nationwide assessment using Global Burden of Disease (GBD) 2021 estimates has revealed striking geographic and demographic disparities in the burden of rheumatoid arthritis (RA) across the United States. The findings, presented at ACR Convergence and published in Arthritis & Rheumatology, underscore how state-specific trends in smoking, age, and gender contribute to unequal health outcomes, reinforcing the need for targeted, equity-focused public health interventions.

“Rheumatoid arthritis (RA) is an autoimmune, systemic disease with a rising U.S. healthcare burden,” the authors noted. “Utilizing Global Burden of Disease (GBD) 2021 estimates, we analyzed sex, age, and state specific trends in prevalence, incidence, Disability-Adjusted Life Year (DALY), and death, including attributable smoking burden.”

The descriptive analysis included data from all 50 states and the District of Columbia between 1990 and 2021. Researchers examined age-standardized RA prevalence, incidence, DALY, and mortality rates, stratified by sex and age. Choropleth maps illustrated geographic disparities, while box plots compared state-level and gender-based variations. States were grouped by the magnitude and temporal trends in smoking-attributable RA DALY percentages.

Key Findings:

• Geographic hotspots: Montana, Wyoming, and New Mexico consistently ranked in the top three states for RA burden. Montana had the highest prevalence (464.73 per 100,000) and DALY rate (73.17).

• Lowest burden: The District of Columbia, California, and Mississippi reported the lowest RA prevalence and DALY rates.

• Age disparities: The burden increased with age, peaking in those aged 55+ (DALY: 162.8; prevalence: 1,014.63; incidence: 46.98; death: 2.16), while individuals under 20 had minimal burden (DALY: 4.44; death: 0.00).

• Gender gap: Across all states, females had significantly higher RA burden than males. For example, in Montana, the female DALY rate was 104.4 vs. 41.77 for males.

• Smoking-attributable burden: While overall smoking-related RA DALY rates declined nationally, states such as Montana, Kentucky, and Wyoming maintained the highest levels from 1990 to 2021. In contrast, Colorado, Minnesota, and Nevada showed marked improvement, while Arkansas, Kentucky, and South Dakota worsened in rank.

“Substantial disparities in RA burden exist across U.S. states, with consistently high rates observed in Montana, Wyoming, and Kentucky,” the authors concluded. “These differences are further amplified by sex- and age-specific trends, with older adults and females bearing a disproportionate burden.”

Despite national progress in reducing smoking-attributable RA outcomes, the persistently high or worsening burden in certain regions highlights gaps in tobacco control and equitable care delivery. States like Colorado and Minnesota offer hopeful examples of improvement, but others—including Arkansas and Missouri—remain at elevated risk.

These findings highlight the urgent need for state-specific, gender- and age-sensitive strategies to mitigate RA burden and modifiable risks like smoking. Recommendations include:

• Stricter tobacco control policies

• Tailored public health campaigns

• Improved access to rheumatologic care via telehealth

• Early screening for high-risk populations within primary care

Reference
Chirumamilla P, Majety S, Nimmagadda R, et al. Geographic and demographic patterns of rheumatoid arthritis in the United States: insights from GBD 2021 [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/geographic-and-demographic-patterns-of-rheumatoid-arthritis-in-the-united-states-insights-from-gbd-2021
Accessed October 15, 2025.