Epidemiological Analysis: Chronic Health Problem essay

Epidemiological Analysis: Chronic Health Problem

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Epidemiological Analysis: Chronic Health Problem

Identification of the Health Problem

The health problem under review in this paper is Rheumatoid Arthritis (RA). According to the CDC (2020), RA refers to an inflammatory and autoimmune disease whereby a person’s immune system mistakenly attacks the healthy cells in his/her body leading to inflammation in the affected boy parts. This disease often attacks the joints in the knees, wrists, and hands. RA causes inflammation in the linings of a joint and damages the joint tissue. Consequently, the tissue damage may lead to chronic pain, deformity, and unsteadiness. This is a serious disease that adversely impacts a person’s productivity and overall quality of life. To understand the significance of RA, this paper presents comprehensive research of the disease and offers context in the form of state and national data. The state of focus, in this case, is Illinois. By investigating the surveillance/ reporting methods of RA, the epidemiology of RA, and the screening/diagnosis guidelines, a plan of action is developed based on evidence-based interventions.

Background and Significance of the Health Problem

Each year in the US, approximately 71 out of 100, 000 people are diagnosed with RA. This translates to around 1.5 million people with RA in the country (Hunter et al., 2019). In Illinois, the prevalence of the disease aligns with the national data. Out of a population of around 12.67 million, approximately 100,000 people in Illinois have been diagnosed with RA. The trends of both national and state data reveal that women have a higher likelihood of getting RA compared to men. For US adults, the lifetime risk of getting RA is 1.7% for men and 3.6% for women (Hunter et al., 2019). It is asserted that the hormones in both genders tend to play a huge role in the prevention or triggering of the disease. Although RA can target people of all ages, it is mostly prevalent in adults. The table below gives a brief overview of RA-related state and federal data.

Table 1: RA-Related State and Federal Data

Item

State

Federal

Population

12.67 million

329.5 million

No. of people with RA (Approx.)

100,000

1.5 million

Prevalence Based on Gender (Approx.)

1.7% for men and 3.6% for women

1.7% for men and 3.6% for women

Associated Healthcare Costs (Approx.)

$1.7 billion

$20 billion

The state and national data reveal similar trends in the risk factors and prevalence rates of people with RA. As aforementioned, women have a higher likelihood of getting RA than men. Also, the prevalence of the disease rises with an increase in age. People over the age of 65 are six times more likely to have RA than those in the 18-44 age bracket. When it comes to race, Asian adults show a lower prevalence of getting the disease compared to multiracial, black, white, and American Indian adults. Another risk factor is education with statistics showing the less education one has, the higher the chances of getting RA. Similarly, the less income one has, the higher the chances of having the disease. Finally, people who are physically inactive are more at risk of getting the disease than those who are physically active. Other lifestyle factors like obesity and smoking, in addition to jobs that require repetitive squatting and bending, may increase one’s chances of having RA.

RA is a big problem in both Illinois and the country as a whole. For starters, RA increases the probability of a person contracting other diseases such as stroke and heart disease. It can also impact a person’s eyes, blood, lungs, and vascular system. Consequently, RA has adverse consequences for the state and federal healthcare costs. It is estimated that anyone with RA is likely to spend $5,720 in relevant healthcare costs (Raimundo et al., 2019). This figure can rise up to $20,000 in extreme cases (Raimundo et al., 2019). Additionally, the costs related to the quality of life for a person with RA also increase. This is because a person with RA has a higher chance of needing help with personal care and having activity limitations. These limitations may impact his/her productivity and ability to get regular income (Lundkvist, Kastäng, & Kobelt, 2018).

Current Surveillance and Reporting Methods

At both the state and national levels, public health departments utilize passive disease surveillance to promote good health and prevent disease in the context of RA. This system is essential in ensuring that it is possible to monitor the trends related to RA and facilitate the planning of relevant public health programs. Passive surveillance implies that healthcare providers are tasked with the initiating of reporting to the national and state officials, reportable instances of RA are submitted to the officials on a case-by-case basis. It is vital to note that there is no mandatory reporting of RA since this is not an infectious or communicable disease that can swiftly threaten the general population.

Passive surveillance is effective for the monitoring and reporting of RA since it casts a wide net on the general population and can be easily implemented. The challenge is that it normally leads to incomplete and underreporting of data. More so, considering that RA does not fall under the group of diseases that require mandatory reporting, many cases of RA go unreported. Hence, there is a high probability that the prevalence of the disease is higher than currently reported (Raimundo et al., 2019).

Currently, the CDC uses an arthritis case definition to monitor and report cases of RA in Illinois and the rest of the country. Case definitions are important in allowing public health officials to classify and count RA cases consistently across various geographical territories. The collection of RA data is further facilitated by the National Health Interview Survey and the Behavioral Risk Factor Surveillance System (Li et al., 2018). The former offers vital information regarding the percentage and number of individuals who have been diagnosed with RA, the trend of the percentages/numbers in the context of rising or falling, and the impact of RA on the quality of life of its victims.

Descriptive Epidemiology Analysis of Health Problem

According to Silman and Pearson (2017), “the descriptive epidemiology of RA is suggestive of a genetic defect.” Silman and Pearson (2017) assert that RA occurrence is considerably constant with a prevalence ranging from 1.5 to 1.0 percent frequency in the general American population. The five Ws of epidemiology offer a more comprehensive insight into RA:

a) Who: Women are three times more likely to be affected by RA compared to men. Also, the older a person gets, the higher the likelihood of the individual being diagnosed with the disease. RA has also been shown to be more common in poor households and individuals with limited education. Regarding race, Asian adults show a lower prevalence of getting the disease compared to multiracial, black, white, and American Indian adults.

b) What: RA is not an infectious disease. However, it has adverse impacts on the people who get diagnosed with it. It also has negative consequences to the community as a whole. RA increases the probability of a person contracting other diseases such as stroke and heart disease. RA also results in higher state and federal healthcare costs. It is also vital to acknowledge the costs related to the quality of life for a person with RA. This is because a person with RA has a higher chance of needing help with personal care and having activity limitations. These limitations may impact his/her productivity and ability to get regular income.

c) When: RA has been prevalent in Illinois and the rest of the country for as long as written records have been available. Symptoms of the disease can be identified throughout history based on historical texts that predate modern medicine. Therefore, RA is not a new disease but rather one that has been plaguing many people throughout history. This is because the risk factors of the disease are mainly hereditary, age-based, and lifestyle-based.

d) Where: The exact origins of RA are currently unknown. However, researchers have attributed RA to various causes. For instance, Boissier et al (2020) assert that the genetic predisposition of RA can be traced to MHC class II genes. Boissier et al (2020) add that non-genetic factors can account for the rest of the reasons. However, Svartz (2015) suggests that a bacterial infection is the origin of RA. This argument notes that the infection led to the changes seen in the macrophages with the subsequent enzyme release and secondary abnormal immune processes.

e) Why: As aforementioned, RA is attributed to genetic and lifestyle factors. Therefore, early screening can help identify a person’s genetic predisposition to the disease and help chart a treatment and management intervention before the symptoms of the disease become unmanageable. Identifying risk factors can help people to avoid the negative behaviors that can lead them into developing RA.

Screening & Diagnosis Guidelines

The screening and diagnosis of RA do not rely on one test but rather a combination of medical history, lab tests, physical exams, and imaging tests (Sharma et al., 2020). First, the medical history will reveal the past and current symptoms of the patients, which are related to RA, for instance, stiffness, swelling, and pain. The family medical history of the patients may also help point out possible genetic connections to the disease. Second, the physical examination will help the rheumatologist to test the patient’s joints for things like range of motion, tenderness, and swelling. Third, the lab tests will also be necessary to disprove or confirm RA. The lab tests are vital for the differential diagnosis so that the rheumatologist is sure of whether the patient has RA or simply has symptoms that are synonymous with RA. Examples of such tests include the C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) blood tests. These tests detect and measure the body’s inflammation levels (Sharma et al., 2020). Other tests are the anti-CCP and the rheumatoid factor, which are antibody tests that search for RA-associated proteins. Finally, imaging tests such as ultrasounds and X-rays may be vital in diagnosing or ruling out RA in an individual. Due to the comprehensive nature of this diagnostic and screening process, the validity and reliability of the entire process used to check for RA are significantly high.

Plan of Action

After graduation, the nurse will address the issue of RA in Illinois and the country as a whole by advocating for and implementing three evidence-based interventions. First, there is the primary intervention. This will take the form of an education and sensitization drive where the members of the public will be regularly educated on RA, risk factors, and the lifestyle habits to avoid or embrace in order to avoid contracting the disease in the first place (van Boheemen et al., 2021). This is a preventive-based solution, which is essential in reducing the number of people who develop RA in the country. This preventive solution will ensure that people avoid poor lifestyle habits such as sedentary living, poor diets, smoking, and excessive alcohol consumption. These are habits that put one at a high risk of getting RA.

Second, there is the secondary intervention. This will take the form of mass screening. According to Adami and Saag (2019), mass screening programs are essential for the detection of inapparent diseases; these are diseases characterized by a silent/latent period where early diagnosis and subsequent treatment tend to lead to enhanced positive healthcare outcomes. In Illinois and the rest of the country, mass screening programs will ensure that there is the detection of RA as early as possible within members of the public. The earlier the detection of RA can be done, the sooner the treatment and therapy can commence. It is easier to handle the disease early before its symptoms become worse. More so, it will reduce the healthcare costs related to the treatment of RA and will enhance the productivity and quality of life of the affected individual in the long run.

Finally, there is the tertiary intervention. This will be characterized by the enhanced treatment of RA. Bullock et al. (2018) note that one common misconception about RA is that the disease cannot be treated. Although RA has no cure, Bullock et al. (2018) assert that early treatment with certain medications tends to be efficient in pushing the symptoms of RA into remission. These medications are commonly referred to as disease-modifying anti-rheumatic drugs. The objective of this intervention will be to enhance the quality of life of the affected individuals in order to ensure that they are dependent on others and are more productive in society.

Outcomes of the interventions will be measured by conducting a survey to check if there is a drop in the number of people who get diagnosed with RA after every one-year period. It is expected that the preventive measures will ensure people live healthier lifestyles leading to fewer new cases of RA. Also, it is expected that the healthcare costs related to the treatment of RA will be significantly reduced. The integration of health policy advocacy will be vital to ensure that regulations and policies are put in place to support the active implementation and funding of the three interventions mentioned.

Conclusion

RA is a big problem in both Illinois and the country as a whole. RA increases the probability of a person contracting other diseases such as stroke and heart disease. Consequently, RA has adverse consequences for the state and federal healthcare costs. It is estimated that anyone with RA is likely to spend $5,720 in relevant healthcare costs (Raimundo et al., 2019). Additionally, the costs related to the quality of life for a person with RA also increase. This is because a person with RA has a higher chance of needing help with personal care and having activity limitations. These limitations may impact his/her productivity and ability to get regular income (Lundkvist, Kastäng, & Kobelt, 2018). To this end, three evidence-based interventions have been identified to deal with the RA problem.

First, there is the primary intervention. This will take the form of an education and sensitization drive where the members of the public will be regularly educated on RA, risk factors, and the lifestyle habits to avoid or embrace in order to avoid contracting the disease in the first place (van Boheemen et al., 2021). Second, there is the secondary intervention. This will take the form of mass screening. According to Adami and Saag (2019), mass screening programs are essential for the detection of inapparent diseases. Finally, there is the tertiary intervention. This will be characterized by the enhanced treatment of RA. Although RA has no cure, Bullock et al. (2018) assert that early treatment with certain medications tends to be efficient in pushing the symptoms of RA into remission.

References

Adami, G., & Saag, K. G. (2019). Osteoporosis pathophysiology, epidemiology, and screening in rheumatoid arthritis. Current Rheumatology Reports, 21(7), 1-10.

Boissier, M. C., Biton, J., Semerano, L., Decker, P., & Bessis, N. (2020). Origins of rheumatoid arthritis. Joint Bone Spine, 87(4), 301-306.

Bullock, J., Rizvi, S. A., Saleh, A. M., Ahmed, S. S., Do, D. P., Ansari, R. A., & Ahmed, J. (2018). Rheumatoid arthritis: A brief overview of the treatment. Medical Principles and Practice, 27(6), 501-507.

CDC. (2020, July). Rheumatoid arthritis (RA). Centers for Disease Control and Prevention. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html

Hunter, T. M., Boytsov, N. N., Zhang, X., Schroeder, K., Michaud, K., & Araujo, A. B. (2019). Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004–2014. Rheumatology International, 37(9), 1551-1557.

Li, C., Balluz, L. S., Ford, E. S., Okoro, C. A., Zhao, G., & Pierannunzi, C. (2018). A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007–2008. Preventive Medicine, 54(6), 381-387.

Lundkvist, J., Kastäng, F., & Kobelt, G. (2018). The burden of rheumatoid arthritis and access to treatment: Health burden and costs. The European Journal of Health Economics, 8(2), 49-60.

Raimundo, K., Solomon, J. J., Olson, A. L., Kong, A. M., Cole, A. L., Fischer, A., & Swigris, J. J. (2019). Rheumatoid arthritis–interstitial lung disease in the United States: prevalence, incidence, and healthcare costs and mortality. The Journal of Rheumatology, 46(4), 360-369.

Sharma, S., Ghosh, S., Singh, L. K., Sarkar, A., Malhotra, R., Garg, O. P., … & Biswas, S. (2020). Identification of autoantibodies against transthyretin for the screening and diagnosis of rheumatoid arthritis. PLoS One, 9(4), e93905.

Silman, A. J., & Pearson, J. E. (2017). Epidemiology and genetics of rheumatoid arthritis. Arthritis Research & Therapy, 4(3), 1-8.

Svartz, N. (2015). The origin of rheumatoid arthritis. Rheumatology, 6, 322-328.

van Boheemen, L., Ter Wee, M. M., Seppen, B., & van Schaardenburg, D. (2021). How to enhance recruitment of individuals at risk of rheumatoid arthritis into trials aimed at prevention: Understanding the barriers and facilitators. RMD Open, 7(1), e001592.