Background/Purpose: Rheumatoid arthritis (RA), a chronic systemic inflammatory disorder, imposes a significant global health burden. Smoking is a well-established modifiable risk factor implicated in both the onset and progression of RA. However, comprehensive estimates of the global burden of RA attributable to smoking over time remain limited. This study aims to quantify the burden of RA attributable to smoking across 204 countries and territories over a 32-year period, disaggregated by age, sex, and location.

Methods: We estimated deaths, DALYs, and YLDs attributable to smoking-related RA from 1990 to 2021 across 204 countries and territories using a standardized global burden of disease study 2021 risk attribution framework. Burden estimates were stratified by age, sex, year, and geography. Counterfactual analysis assuming zero smoking exposure was applied to compute attributable fractions, and temporal trends were assessed using annual percentage change in age-standardized rates and absolute counts.

Results: Between 1990 and 2021, the total number of deaths due to RA attributable to smoking increased from 1,791 (95% UI: 1,323–2,227) to 2,263 (1,509–2,911). During the same period, DALYs rose from 145,727 (102,543–200,899) to 215,779 (147,152–300,761), and YLDs increased from 102,310 (65,671–151,392) to 166,709 (107,433–247,042). From 1990 to 2021, smoking-attributable deaths due to RA declined in High SDI regions (APC: –1.04%) and High-income settings (–0.99%), while increasing in High-middle SDI regions (APC: +1.91%). In contrast, DALYs rose substantially in High-middle SDI regions (APC: +2.48%) and to a lesser extent in Central and Eastern Europe (+0.79%) and High-income regions (+0.18%), reflecting a shifting burden from mortality to chronic disability. By 2021, individuals aged 50–54 years recorded the highest burden with 21,342 DALYs and 16,213 YLDs, showing consistent increases since 1990 (APC: +0.84% and +0.96%, respectively). In 2021, females accounted for 57% of total DALYs and 61% of YLDs, with a slower decline in mortality rates compared to males (APC: –0.88% vs –1.15%).

Conclusion: In the last 3 decades, the global burden of RA attributable to smoking revealed a complex epidemiological shift—mortality declined in several high-income regions, while DALYs and YLDs rose markedly in Eastern Europe, Central Asia, and Southern Latin America. The disproportionate rise among midlife adults and females highlights a growing chronic disability gap. These findings emphasize the need for integrated, region-specific strategies that extend beyond tobacco cessation to address the long-term inflammatory consequences of smoking.

Global Burden of Rheumatoid Arthritis attributable to Smoking in 204 Countries and Territories from 1990-2021, Annual Percentage of change, Age-standardized DALYs rate per 100,000, Both Sexes

Global Burden of Rheumatoid Arthritis attributable to Smoking in 204 Countries and Territories from 1990-2021, Annual Percentage of change, Age-standardized Deaths rate per 100,000, Both Sexes

Age-Sex wise Burden of Rheumatoid Arthritis attributable to Smoking in 204 Countries and Territories from 1990-2021, Annual Percentage of change, absolute counts-Deaths, DALYs, and YLDs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quantifying-the-inflammatory-toll-smoking-attributable-rheumatoid-arthritis-burden-across-the-globe-1990-2021/