Using a Novel Approach to Evaluate the Population-Level Burden of Disability Among Working-Age Individuals with Rheumatoid Arthritis

Objectives Individuals with rheumatoid arthritis (RA) may experience work disability, yet population-level data on disability prevalence are limited. We quantified the prevalence of working-age individuals with RA with disability-related RA medication claims and assessed disability-related medication claims in the general population for comparison. Methods We conducted a population-based repeated cross-sectional study using Ontario health administrative databases to assess annual trends from 2000 to 2022. We identified medication claims funded through the Ontario Disability Support Program (ODSP) within the Ontario Drug Benefit (ODB) database. We identified individuals with RA from the Ontario Rheumatoid Arthritis Database. Annual denominators comprised the number of RA individuals between the ages of 20-64 years, alive, with Ontario Health Insurance Plan coverage in the given measurement year. Individuals contributed to annual denominators until death, outmigration, attainment of age 65 (transitioning to ODB Seniors Program) or study end date. Annual numerators comprised the number of RA individuals with at least one ODSP-attributed medication claim for biologic, conventional, or targeted synthetic DMARDs, NSAIDs, opioids, or systemic glucocorticoids. We further quantified the total volume and medication-related costs attributed to these claims funded through ODSP. For comparison, we ascertained disability-related claims (for any medication class) among the general Ontario population aged 20 to 64 years. Results Over the 23-year period, the number of RA individuals aged 20-64 years grew from 34,394 to 74,182 individuals, while the number of RA individuals with a disability RA medication claim increased from 2,805 individuals in 2000 to 6,270 individuals in 2022, corresponding to a stable annual disability prevalence of 8-9% of all RA working aged individuals (a pattern driven by individuals transitioning to ODB Senior Program at 65). Regional disability prevalence was lowest in the central region (4.8%) and highest in the Northeast (12.6%). The annual volume of ODSP RA medication claims ranged from 55,611 in 2000 to a peak in 2020 of 255,810 claims, corresponding to annual costs of $1,894,925CAD and $33,215,527CAD respectively (Figure). In contrast, the disability prevalence in the general population ranged from 2.7-3.8% during the study period. Conclusion Over 2 decades, the number of working-age RA individuals receiving disability benefits doubled, and RA disability prevalence was twice that of the general population. Nearly 1 in 11 younger RA adults were on disability annually, contributing to substantial medication use and economic costs. Investment in effective, evidence-based care models is needed to preserve work participation and reduce the long-term impacts of RA-related disability.