{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:11:31Z","timestamp":1792519891972,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012131","name":"Department of Science and Technology of Liaoning Province","doi-asserted-by":"publisher","award":["2023JH2\/101700124"],"award-info":[{"award-number":["2023JH2\/101700124"]}],"id":[{"id":"10.13039\/501100012131","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012131","name":"Department of Science and Technology of Liaoning Province","doi-asserted-by":"publisher","award":["2024JH2\/102600270"],"award-info":[{"award-number":["2024JH2\/102600270"]}],"id":[{"id":"10.13039\/501100012131","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Elderly-onset rheumatoid arthritis (EORA) poses a growing public health burden worldwide. Significant health inequalities and frontier gaps persist across countries, while the impact of smoking on EORA has evolved over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using data from the 2021 Global Burden of Disease data, we assessed the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of EORA and analyzed trends by calculating the estimated annual percentage changes. We explored associations with the sociodemographic index (SDI), evaluated frontier gaps, quantified health inequalities, examined the impact of smoking, and predicted trends to 2050 using Bayesian age-period-cohort (BAPC) models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 2021, global EORA case numbers were as follows: incidence: 0.33 million (95% uncertainty interval [UI]: 0.22, 0.47), prevalence: 7.92 million (95% UI: 6.90, 9.10), mortality: 33.20 thousand (95% UI: 26.86, 38.57), and DALYs: 1.55 million (95% UI: 1.23, 1.93). The disease burden was higher in females than in males, with high SDI-regions such as Australia experiencing the highest burden. Trends varied across different regions and countries; India and China had the highest case numbers, whereas Guam and Singapore showed significant improvements in mortality rates. Cross-national inequality analysis revealed significant disparities in disease burden. Frontier analysis identified considerable potential for improvement in disease burden in several countries and regions. The impact of smoking on EORA has declined, but BAPC model projections indicate that the burden will continue to rise until 2050.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Elderly-onset rheumatoid arthritis has become a significant public health concern. Addressing socio-economic inequalities, enhancing monitoring systems, and implementing targeted prevention and treatment strategies are crucial for alleviating the global EORA burden.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1664232","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T05:27:39Z","timestamp":1759987659000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Unveiling health inequalities and frontier gaps in elderly-onset rheumatoid arthritis: evolving impact of smoking and future challenges"],"prefix":"10.3389","volume":"12","author":[{"given":"Yan","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfeng","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoxiang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1002\/art.1780290406","article-title":"The development of disability in rheumatoid arthritis.","volume":"29","author":"Sherrer","year":"1986","journal-title":"Arthritis Rheum."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e070856","DOI":"10.1136\/bmj-2022-070856","article-title":"Therapeutic advances in rheumatoid arthritis.","volume":"384","author":"Brown","year":"2024","journal-title":"BMJ."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.","volume":"396","year":"2020","journal-title":"Lancet."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e241139","DOI":"10.1001\/jamanetworkopen.2024.1139","article-title":"Rheumatoid arthritis and risk of depression in South Korea.","volume":"7","author":"Jeon","year":"2024","journal-title":"JAMA Netw Open."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1016\/S2665-9913(24)00221-2","article-title":"Factors associated with biological and targeted synthetic disease-modifying antirheumatic drug initiation for rheumatoid arthritis in underserved patient groups in England and Wales, UK: a national cohort study.","volume":"7","author":"Russell","year":"2025","journal-title":"Lancet Rheumatol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1196\/annals.1351.019","article-title":"Epidemiological aspects of rheumatoid arthritis: the sex ratio.","volume":"1069","author":"Kvien","year":"2006","journal-title":"Ann N Y Acad Sci."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e082966","DOI":"10.1136\/bmjopen-2023-082966","article-title":"Global trends in the burden of rheumatoid arthritis by sociodemographic index: a joinpoint and age-period-cohort analysis based on the Global Burden of Disease Study 2019.","volume":"14","author":"Chen","year":"2024","journal-title":"BMJ Open."},{"key":"B8","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1093\/rheumatology\/kead269","article-title":"The global magnitude and temporal trend of rheumatoid arthritis burden attributable to smoking from 1990 to 2019.","volume":"63","author":"Wang","year":"2024","journal-title":"Rheumatology."},{"key":"B9","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/0049-0172(94)90087-6","article-title":"Elderly-onset rheumatoid arthritis.","volume":"23","author":"van Schaardenburg","year":"1994","journal-title":"Semin Arthritis Rheum."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1136\/ard.2005.051144","article-title":"Do patients with older-onset rheumatoid arthritis receive less aggressive treatment?","volume":"65","author":"Tutuncu","year":"2006","journal-title":"Ann Rheum Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e20230411","DOI":"10.1590\/1806-9282.20230411","article-title":"Temporomandibular joint involvement in elderly onset and young onset rheumatoid arthritis patients.","volume":"69","author":"Ilhanli","year":"2023","journal-title":"Rev Assoc Med Bras."},{"key":"B12","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1136\/annrheumdis-2020-218282","article-title":"Burden and trajectory of multimorbidity in rheumatoid arthritis: a matched cohort study from 2006 to 2015.","volume":"80","author":"England","year":"2021","journal-title":"Ann Rheum Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s40266-015-0341-2","article-title":"Targeting low disease activity in elderly-onset rheumatoid arthritis: current and future roles of biological disease-modifying antirheumatic drugs.","volume":"33","author":"Sugihara","year":"2016","journal-title":"Drugs Aging."},{"key":"B14","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1093\/mr\/roab087","article-title":"Treatment strategies for elderly-onset rheumatoid arthritis in the new era.","volume":"32","author":"Sugihara","year":"2022","journal-title":"Mod Rheumatol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.","volume":"403","year":"2024","journal-title":"Lancet."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e594","DOI":"10.1016\/S2665-9913(23)00211-4","article-title":"Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021.","volume":"5","year":"2023","journal-title":"Lancet Rheumatol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.1016\/S0140-6736(16)30388-9","article-title":"Guidelines for accurate and transparent health estimates reporting: the GATHER statement.","volume":"388","author":"Stevens","year":"2016","journal-title":"Lancet."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1016\/S0140-6736(21)01546-4","article-title":"Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019.","volume":"398","year":"2021","journal-title":"Lancet."},{"key":"B19","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1002\/art.1780310302","article-title":"The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.","volume":"31","author":"Arnett","year":"1988","journal-title":"Arthritis Rheum."},{"key":"B20","doi-asserted-by":"publisher","first-page":"103958","DOI":"10.1016\/j.esmoop.2024.103958","article-title":"Global trends in adolescent and young adult female cancer burden, 1990-2021: insights from the Global Burden of Disease study.","volume":"9","author":"Huang","year":"2024","journal-title":"ESMO Open."},{"key":"B21","doi-asserted-by":"publisher","first-page":"102758","DOI":"10.1016\/j.eclinm.2024.102758","article-title":"Global, regional, and national burden of ischemic stroke, 1990-2021: an analysis of data from the global burden of disease study 2021.","volume":"75","author":"Li","year":"2024","journal-title":"EClinicalMedicine."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e1388","DOI":"10.1016\/S2214-109X(19)30360-2","article-title":"Rheumatic heart disease burden, trends, and inequalities in the Americas, 1990-2017: a population-based study.","volume":"7","author":"Ordunez","year":"2019","journal-title":"Lancet Glob Health."},{"key":"B23","doi-asserted-by":"publisher","first-page":"103326","DOI":"10.1016\/j.autrev.2023.103326","article-title":"Global burden and cross-country inequalities in autoimmune diseases from 1990 to 2019.","volume":"22","author":"Cao","year":"2023","journal-title":"Autoimmun Rev."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1521770","DOI":"10.3389\/fnut.2024.1521770","article-title":"An analysis of the global burden of gallbladder and biliary tract cancer attributable to high BMI in 204 countries and territories: 1990-2021.","volume":"11","author":"Hu","year":"2024","journal-title":"Front Nutr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"102873","DOI":"10.1016\/j.eclinm.2024.102873","article-title":"The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040.","volume":"77","author":"Bai","year":"2024","journal-title":"EClinicalMedicine."},{"key":"B26","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1002\/art.38306","article-title":"The epidemiology of rheumatoid arthritis in Ontario, Canada.","volume":"66","author":"Widdifield","year":"2014","journal-title":"Arthritis Rheumatol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2297","DOI":"10.1007\/s10067-023-06628-2","article-title":"Estimation of the global prevalence, incidence, years lived with disability of rheumatoid arthritis in 2019 and forecasted incidence in 2040: results from the Global Burden of Disease Study 2019.","volume":"42","author":"Shi","year":"2023","journal-title":"Clin Rheumatol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.5114\/aoms\/183955","article-title":"Global, regional, and national burdens of rheumatoid arthritis in young adults from 1990 to 2019.","volume":"20","author":"Zhang","year":"2024","journal-title":"Arch Med Sci."},{"key":"B29","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/1756-185X.12320","article-title":"Challenges and opportunities in the early diagnosis and optimal management of rheumatoid arthritis in Africa and the Middle East.","volume":"18","author":"Halabi","year":"2015","journal-title":"Int J Rheum Dis."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.5114\/aoms\/162629","article-title":"Increasing global burden of rheumatoid arthritis: an epidemiological analysis from 1990 to 2019.","volume":"19","author":"Zou","year":"2023","journal-title":"Arch Med Sci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"3576","DOI":"10.1093\/rheumatology\/kead106","article-title":"Mortality estimates and excess mortality in rheumatoid arthritis.","volume":"62","author":"Black","year":"2023","journal-title":"Rheumatology."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2799","DOI":"10.1007\/s10067-024-07083-3","article-title":"Trends and future projections of incidence rate and mortality of rheumatoid arthritis in China: a systematic analysis based on GBD 2021 data.","volume":"43","author":"Gu","year":"2024","journal-title":"Clin Rheumatol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1159\/000212707","article-title":"Origin and age-associated changes in the expression of a physiologic autoantibody.","volume":"31","author":"Fong","year":"1985","journal-title":"Gerontology."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1136\/annrheumdis-2019-215920","article-title":"Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017.","volume":"78","author":"Safiri","year":"2019","journal-title":"Ann Rheum Dis."},{"key":"B35","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1186\/s12890-023-02594-2","article-title":"Secular trend of mortality and incidence of rheumatoid arthritis in global,1990-2019: an age period cohort analysis and joinpoint analysis.","volume":"23","author":"Yu","year":"2023","journal-title":"BMC Pulm Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s40744-020-00267-8","article-title":"Features and outcomes of elderly rheumatoid arthritis: does the age of onset matter? A comparative study from a single center in China.","volume":"8","author":"Ke","year":"2021","journal-title":"Rheumatol Ther."},{"key":"B37","doi-asserted-by":"publisher","first-page":"195","DOI":"10.2217\/17455057.4.2.195","article-title":"Rheumatoid arthritis: a female challenge.","volume":"4","author":"Gerosa","year":"2008","journal-title":"Womens Health."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1002\/acr.23194","article-title":"Association between menopausal factors and the risk of seronegative and seropositive rheumatoid arthritis: results from the nurses\u2019 health studies.","volume":"69","author":"Bengtsson","year":"2017","journal-title":"Arthritis Care Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"30","DOI":"10.2165\/00002512-199507010-00004","article-title":"Rheumatoid arthritis in the elderly. Prevalence and optimal management.","volume":"7","author":"van Schaardenburg","year":"1995","journal-title":"Drugs Aging."},{"key":"B40","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1111\/1756-185X.12861","article-title":"Comparison of elderly- and young-onset rheumatoid arthritis in an Asian cohort.","volume":"20","author":"Tan","year":"2017","journal-title":"Int J Rheum Dis."},{"key":"B41","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019.","volume":"397","year":"2021","journal-title":"Lancet."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1136\/ard.2009.114694","article-title":"Silica exposure among male current smokers is associated with a high risk of developing ACPA-positive rheumatoid arthritis.","volume":"69","author":"Stolt","year":"2010","journal-title":"Ann Rheum Dis."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/j.clinthera.2019.04.021","article-title":"Potential of lifestyle changes for reducing the risk of developing rheumatoid arthritis: is an ounce of prevention worth a pound of cure?","volume":"41","author":"Zaccardelli","year":"2019","journal-title":"Clin Ther."},{"key":"B44","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1111\/imj.15537","article-title":"Rheumatoid arthritis is a preventable disease: 11 ways to reduce your patients\u2019 risk.","volume":"52","author":"Koller-Smith","year":"2022","journal-title":"Intern Med J."},{"key":"B45","doi-asserted-by":"publisher","first-page":"e068208","DOI":"10.1136\/bmj-2021-068208","article-title":"Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study.","volume":"376","year":"2022","journal-title":"BMJ."},{"key":"B46","doi-asserted-by":"publisher","first-page":"102713","DOI":"10.1016\/j.eclinm.2024.102713","article-title":"Global, regional, and national burden of female cancers in women of child-bearing age, 1990-2021: analysis of data from the global burden of disease study 2021.","volume":"74","author":"Sun","year":"2024","journal-title":"EClinicalMedicine."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1664232\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T05:27:40Z","timestamp":1759987660000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1664232\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":46,"alternative-id":["10.3389\/fmed.2025.1664232"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1664232","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]},"article-number":"1664232"}}