Epidemiology and socioeconomic impact of the rheumatic diseases on indigenous people: an invisible syndemic public health problem

Abstract

<jats:p>Epidemiological studies in Latin America suggest indigenous people lack proper healthcare for musculoskeletal (MSK) and rheumatic diseases.</jats:p><jats:sec><jats:title>Objectives</jats:title><jats:p>This study aimed to estimate the prevalence of MSK disorders and rheumatic diseases in eight Latin American indigenous communities, and to identify which factors influence such prevalence using network analysis and syndemic approach.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a cross-sectional, community-based census study according to Community-Oriented Program for the Control of Rheumatic Diseases methodology. Individuals with MSK pain, stiffness or swelling in the past and/or during the last 7 days were evaluated by participating physicians. A descriptive, univariable and multivariable analysis was performed, followed by a network analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We surveyed 6155 indigenous individuals with a mean age of 41.2 years (SD 17.6; range 18–105); 3757 (61.0%) were women. Point prevalence in rank order was: low back pain in 821 (13.3%); osteoarthritis in 598 (9.7%); rheumatic regional pain syndromes in 368 (5.9%); rheumatoid arthritis in 85 (1.3%); undifferentiated arthritis in 13 (0.2%); and spondyloarthritis in 12 (0.1%). There were marked variations in the prevalence of each rheumatic disease among the communities. Multivariate models and network analysis revealed a complex relationship between rheumatic diseases, comorbidities and socioeconomic conditions.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The overall prevalence of MSK disorders in Latin American indigenous communities was 34.5%. Although low back pain and osteoarthritis were the most prevalent rheumatic diseases, wide variations according to population groups occurred. The relationship between rheumatic diseases, comorbidities and socioeconomic conditions allows taking a syndemic approach to the study.</jats:p></jats:sec>

Treatment failure in inflammatory arthritis: time to think about syndemics?

“…A recent study exploring the prevalence of musculoskeletal disorders in Latin American indigenous communities demonstrated for the first time the close relationship between rheumatic diseases, comorbidities and socioeconomic conditions [73]. Among the American indigenous communities, diabetes comorbidity ranged from 0.7% to 10%, heart disease ranged from 1% to 18%, obesity ranged from 7% to 18%, and depression ranged from 5% to 12%.…”

Prevalence of rheumatoid arthritis in South America: a systematic review and meta-analysis

“…American Indian and Alaska Native populations with RA also present more extra-articular manifestations, erosive disease and more severe radiographic findings, which are associated with a high frequency of HLA-B27 gene and subtype HLA-DRB1*1402. Additionally, indigenous population share similarities in difficulties in access to healthcare coverage, which may influence clinical outcomes 35,51,52 . Conversely, several studies showed that the frequencies of genetic alleles that increase RA susceptibility are more prevalent in Caucasians than in Africans.…”

Epidemiología, uso de recursos y costos de la artritis reumatoidea en Argentina

“…Esta prevalencia también resulta similar a la reportada en estudios provenientes de Inglaterra, Lituania y América, mientras que la incidencia se encuentra en el rango menor de la tasa global (7,(34)(35)(36) . También es similar a lo reportado por Peláez-Ballesta et al en 2018, en un estudio que describió una prevalencia de AR de 1,3% en cuatro poblaciones indígenas de Latinoamérica; sin embargo, en un subanálisis del mismo estudio, la prevalencia en la comunidad indígena Qom de Argentina fue del 2,4% (37) .…”