Background/Purpose:

Two important reviews have summarized the epidemiology of rheumatic disease (Peschken 1999) and RA (Ferucci 2005) in Indigenous populations of North America. Our objective was to update these reviews, incorporate non-medical databases, and expand the scope to include Indigenous populations of New Zealand and Australia.

Methods: A systematic search was performed in medical (Medline, EMBASE, CINAHL), Indigenous and conference abstract databases (to June 2015). Search terms for Indigenous populations were combined with terms for inflammatory arthritis conditions, connective tissue disorders, crystal arthritis, and osteoarthritis. Studies were included if they reported on the incidence or prevalence of rheumatic disease in Canadian, American, Australian or New Zealand Indigenous populations.

Results:

A total of 5,269 titles and abstracts were reviewed, of which 504 underwent full-text review and 88 met inclusion criteria. Prevalence rates of RA in Alaskan Native populations ranged from 0.6 to 2.4%, mostly similar to those estimated in the general population. RA prevalence was estimated at 2.2 to 6.8% in Blackfeet, Chippewa and Pima American Indian populations, higher than in the general population of the United States. Reported rates in Canadian First Nations ranged from 1.0 to 7.1%, increased compared to the general population by at least two-fold. The prevalence of RA in Australian Indigenous populations was 2.7% compared to 1.9% in non-Indigenous people. New Zealand Maori RA prevalence was estimated at 3.3%. Contemporary studies of SLE found prevalence rates to be 149-159 per 100,000 in Alaskan Natives and 138-263 per 100,000 in Native American populations, increased from historical studies. Canadian Indigenous SLE prevalence was 42-348 per 100,000, and in Australian Indigenous populations was 13-93 per 100,000, at least double that of non-Indigenous populations. Incidence rates of SLE (per 100,000) were 7 in Alaska Natives, up to 30 in American Indians, 11 in Australian Indigenous and up to 7 in Canadian First Nations populations. Spondyloarthropathies affected 0.2-2.7% of Alaska Native populations, and <0.04% of American Indian populations studied; in Canadian Inuit, spondyloarthropathy prevalence was estimated at 0.9%. Ankylosing spondylitis prevalence was estimated at 3.0% in Pima American Indian populations, and 2.3% in Canadian Haida populations, but just 0.4% in First Nations in Alberta, and 0% in New Zealand Maori. Crystal arthropathy prevalence is comparatively low in Alaska Native and Canadian First Nations in contrast to New Zealand Maori populations, where prevalence was 6.4 to 11.1%, significantly higher than non-Maori or European populations. Osteoarthritis prevalence was estimated at 6-22% in Canadian First Nations, 1.5% in Canadian Inuit, 7-32% in Australian Indigenous populations, and 4-6% in New Zealand Maori over 50 years of age.

Conclusion: Rheumatic disease prevalence in North American, Australian and New Zealand Indigenous populations is significantly higher than that of non-Indigenous populations, but with variation in estimates across tribal ancestry relevant to health services planning.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-of-rheumatic-disease-epidemiology-in-the-indigenous-populations-of-canada-the-united-states-australia-and-new-zealand/