Epidemiology of Rheumatoid Arthritis (RA) in rural and urban areas of Poland – 2008–2012
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Health Care Policy Department, Medical University, Łódź, Poland
Public Health Department, Health Sciences Faculty, Medical University, Łódź, Poland
National Health Fund (NFZ), Warsaw, Poland
K. Jonscher Hospital, Łódź, Poland
Military Medical Institute, Warsaw, Poland
Emergency Medicine and Disaster Medicine Institute, Medical University, Łódź, Poland
Hygiene and Epidemiology Department, Medical University, Łódź, Poland
Corresponding author
Andrzej Śliwczyński   

Public Health Department, Health Sciences Faculty, Medical University, Łódź, Poland
Ann Agric Environ Med. 2016;23(2):350-356
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.

Material and 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).

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. 1/3rd 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.

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.

Filipowicz-Sosnowska A, Stanisławska-Biernat E, Zubrzycka-Sienkiewicz A, Reumatoidalne zapalenie stawów (Rheumatoid Arthritis). Reumatologia 2004; 42 (supl): 8–13.
Vandenbroucke JP, Hazevoet HM, Cats A. Survival and cause of death in rheumatoid arthritis: a 25-year prospective follow-up. J. Rheumatol. 1984; 11(2): 158–161.
Mahold KP, et al. Very recent onset rheumatoid arthritis: clinical and serological patient characteristics associated with radiographic progression over the first years of disease. Rheumatology (Oxford), 2007;46(2): 342–9.
Arnett FC, Edworthy SM, Bloch D, et al. The American Rheumatism Association 1987 revised criteria for classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31:315–324.
Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010; 69: 1580–1588.
Green M., Marzo-Ortega H., McGonagle D. et al. Persistence of mild, early inflammatory arthritis: the importance of disease duration, rheumatoid factor and the shared epitope. Arthritis Rheum 1999; 42: 2184–2188.
Cooper NJ. Economic burden of rheumatoid arthritis: a systematic review. Rheumatology 2000; 39: 28–33.
Michaud K, et al. Direct Medical Costs and Their Predictors in Patients With Rheumatoid Arthritis: A Three-Year Study of 7,527 Patients. Arthritis and Rheumatism 2003; 48(10): p. 2750.
Cornelissen PGJ, Rasker JJ, Valkenburg HA. The arthritis sufferer and the community: a comparison of arthritis sufferers in rural and urban areas. Ann Rheumat Dis. 1988; 47: 150–156.
Bernatsky S, Feldman D, De Civita M, Haggerty J, Tousignant P, et al. Optimal care for rheumatoid arthritis: a focus group study. Clin Rheumatol. 2010: 645–57.
Basu N, Steven M. A Comparison of Rural and Urban Rheumatoid Arthritis Populations. Source: Scot Med J. 2009; 54: 7–9.
The Act of 27.08.2004 on healthcare services financed from public funds (Dz. U. of 2008, No. 164, item 1027 as amended).
Regulation of the Minister of Health of 11.01.2010 changing the regulation on guaranteed services within the scope of health programmes (Dz. U. of 2010, no. 05, item 29 as amended); Regulation of the Minister of Health of 02.03.2010 changing the regulation on guaranteed services within the scope of hospital treatment (Dz. U. of 2010, no. 30, item 157 as amended).
Regulation no. 36/2008/DGL by the NFZ President of 19.06.2008 on establishing the conditions of signing and performing of hospital treatment contracts for therapeutic health programmes; Regulation no. 65/2009/DGL by the NFZ President of 19.06.2008 on establishing the conditions of signing and performing of hospital treatment contracts for therapeutic health programmes;
Porta M, A Dictionary of Epidemiology, Oxford University Press, Oxford, 2008, ISBN 978–0–19–531449–6.
16. (accessed 5.06.2013).
The Nomenclature of Territorial Units for Statistical Purposes (NTS) and National Official Register of Territorial Division of the Country – TERYT are available online:
Terapeutyczne Programy Zdrowotne 2012 Leczenie reumatoidalnego zapalenia stawów (RZS) i młodzieńczego idiopatycznego zapalenia stawów (MIZS) o dużej i umiarkowanej aktywności choroby lekami modyfikującymi przebieg choroby (Therapeutic health programmes 2012: The treatment of rheumatoid arthritis (RA) and Juvenile Idiopathic Arthritis (JIA) with significant and moderate disease activity with drugs which modify the course of the disease). p. 4, online: (accessed 5.07.2013).
Kokot F, et al. Choroby wewnętrzne (Internal diseases). Wydawnictwo Lekarskie PZWL. Warszawa 1997:647–653; Bulletin of the World Health Organization; V.81; No.9; 2003; p646.
Silman AJ, Hochberg MC. Epidemiology of the Rheumatic Diseases, Rheumatoid Arthritis, New York, Oxford Univerity Press; 2001: 31–71.
Symmons D, Turner G, Webb R, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology (Oxford) 2002; 41(7): 793–800.
Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum. 2006; 36(3): 182–8.
Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006; 54(1): 226–9.
Centers for Disease Control and Prevention. Public health and aging: projected prevalence of selfreported arthritis or chronic joint symptoms among persons aged >65 years-United States, 2005-2030. MMWR – Morbidity & Mortality Weekly Report. 2003 May 30; 52(21): 489-91.
Abdel-Nasser A.m, Rasker J.J, Vaikenburg H.A, Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis and Rheum. 1997; 27(2): 123–140.
Drapała A, Grabowska Woźniak E, Gryglewicz J, et al. Stan opieki reumatologicznej w Polsce. Streszczenie raportu projektu badawczego (Condition of rheumatological care in Poland. Abstract of a study project report). Uczelnia Łazarskiego, Warszawa 2011 (in Polish).
Gryglewicz J. Świadczenia opieki zdrowotnej w zakresie reumatologii w 2010 r. (Providing of rheumatology health care services in 2010) Uczelnia Łazarskiego, Warszawa 2010.
Tavares R, Pope JE, Tremblay JL, et al., Time to disease-modyfying Antirheumatic Drug Treatment (…). J Rheumatol. 2012; 39(11): 2008–2096.
Feldman DE, Bernatsky S, Haggerty J, et al. Delay in consultation with specialists (..). Arthritis Rheum. 2007; 57(8): 1419–1425.
Xiang Yao-Jun, Dai Sheng-Ming. Prevalence of rheumatic diseases and disability in China. Rheumatol Int. 2009; 29(5): 481–490.
Lekpa F, Ndongo S, Tiendrebeogo J, Ndao A, Daher A, et al. Rheumatoid arthritis in Senegal: a comparison between patients coming from rural and urban areas, in an urban tertiary health care center in Senegal. Clin Rheumatol. 2012: 1617–20.
Patel M. An Epidemiological survey of arthritis in the population of North Gujarat, India. Int J Pharm Sci Res. 2011; 2(2): 325–330.
Rodriguez-Amado J, Pelaez-Ballestas I, Helena Sanin L, et al. Epidemiology of Rheumatic Diseases. A Community-Based Study in Urban and Rural Populations in the State of Nuevo Leon, Mexico. J Rheumatol. 2011; 38 (Supplement: 86): 9–14.
Carmona L, Villaverde V, Hernandez-Garcia C, Ballina J, Gabriel R, et al. The prevalence of rheumatoid arthritis in the general population of Spain. Rheumatol. 2002; 41: 88.
Saag KG, Doebbeling BN, Rohrer JE, et al. Arthritis health service utilization among the elderly: The role of urban-rural residence and other utilization factors. Arthritis Care Res. 1998; 11(3): 177–185.
Kobelt G, Kasteng F. Access to innovative treatments in rheumatoid arthritis in Europe. A report prepared for the European Federation of Pharmaceutical Industry Associations (EFPIA). Lund University (Sweden) Oct. 2009).
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