Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Arthritis Prevalence and Access to Care in Indigenous People: Results of a Population-Based Study.
Lehman1, Allen J., Liang3, Matthew H., Li2, Linda, Esdaile2, John M., Backman5, Catherine L., Jorgensen4, Phyllis, Roberts4, Kim
Arthritis Research Centre of Canada, Vancouver, BC, Canada
Arthritis Research Centre of Canada; University of British Columbia
Harvard, Boston, MA
Kwakiutl District Council Health Centre
University of British Columbia, Vancouver, BC, Canada
North American Indigenous people are believed to have a high prevalence of arthritis yet limited research has examined the burden of arthritis and access to care. Our objectives were to: 1) identify the prevalence of chronic pain in peripheral joints, neck or back with functional limitations; 2) identify the prevalence of reported diagnoses of arthritis; and, 3) evaluate access to care for arthritis, in three on-reserve Indigenous populations.
A household survey of all adults living in three on-reserve communities was performed using a community case-finding strategy. Band Council support was provided and public forums were held to obtain community feedback prior to survey. Surveys were administered face-to-face by three trained interviewers residing in the community. The interview administered to each community member asked about chronic pain in the joint, neck, and back, and related functional limitations. Those indicating functional limitations secondary to arthritis/joint problems were then asked about their access to health care services and barriers to care. Descriptive analyses were conducted.
Of 536 residents of these communities, 402 (75%) completed the initial interview. Participants' mean age was 46 yrs (range=1993), 52% were female, 61% were married and 23% were never married. Thirty-percent (n=119/402) reported a physician or health professional diagnosis of arthritis (excluding fibromyalgia), with 79 identifying specific type(s), including rheumatoid arthritis (n = 27), hip osteoarthritis (OA; n = 24), knee OA (n = 33), hand OA (n = 25), neck/back arthritis (n = 15), or other (n = 12). In comparison, non-age adjusted prevalence estimates reported in national surveys using the same question was 19% for off-reserve Indigenous People and 16% for non-Indigenous people. Chronic joint, neck, or back pain and functional limitations were reported by 41% (166/402). Of these 166 individuals, 140 reported at least one health care professional visit for their problem: family doctor = 75%; physical therapist = 28%; occupational therapist = 20%; rheumatologist = 16%; traditional healer = 15%; dietician = 13%; counsellor or psychologist = 7%. Assistive devices were used by 39%, and 70% used medications in the past 12 mos. Difficulties obtaining care in the past 12 mos were reported by 28% (n=47/166), such as long wait lists (n = 20), difficult access to rheumatologists (n = 19), poor transportation availability and/or high costs (n =16), lack of awareness of health care professional to see (n = 12), high treatment costs (n = 11), and perceived inadequate or culturally inappropriate health care (n = 10).
The burden of arthritis was high in the three Indigenous communities evaluated. The prevalence of reporting a diagnosis of arthritis exceeded that reported in national surveys for off-reserve Indigenous People and non-Indigenous people; and a large proportion (41%) reported chronic joint, neck or back pain with functional limitations. Along with suboptimal access to care, these findings suggest the need for further research to determine the specific types of arthritis and to identify solutions for improving health equity and access to care.
To cite this abstract, please use the following information:
Lehman, Allen J., Liang, Matthew H., Li, Linda, Esdaile, John M., Backman, Catherine L., Jorgensen, Phyllis, et al; Arthritis Prevalence and Access to Care in Indigenous People: Results of a Population-Based Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1538