A national analysis using Global Burden of Disease (GBD) 2021 data highlights significant geographic, age, and sex disparities in the burden of rheumatoid arthritis (RA) across the United States, with some regions showing persistently high rates despite national improvements.

From 1990 to 2021, Montana, Wyoming, and New Mexico consistently ranked among the top 3 states for age-standardized RA prevalence and Disability-Adjusted Life Year (DALY) rates. Montana had the highest prevalence (464.73 per 100,000) and DALY rate (73.17). In contrast, California, the District of Columbia, and Mississippi reported the lowest RA burden.

“Substantial disparities in RA burden exist across U.S. states,” the authors noted in the presentation at ACR Convergence. “These differences are further amplified by sex- and age-specific trends.”

RA burden rose with age, with individuals aged 55 and older experiencing the highest rates across all measured outcomes. Notably, women consistently had higher burden than men. For example, in Montana, the female DALY rate was 104.4, more than twice that of men (41.77).

Smoking-attributable RA burden declined nationally but remained elevated in states such as Montana, Kentucky, and Wyoming, which ranked among the highest from 1990 to 2021. Meanwhile, Colorado and Minnesota showed marked improvements, while Arkansas and South Dakota climbed the ranks, reflecting worsening trends.

“While smoking-attributable RA DALY percentages have declined nationally, several states—particularly Kentucky, Arkansas, and Missouri—continue to show persistently high or worsening burden,” the authors reported.

These findings emphasize the need for state-specific, gender- and age-sensitive interventions. The study calls for enhanced tobacco control policies, targeted public health campaigns, and improved access to rheumatologic care, especially in regions with high RA burden and limited resources.

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/