Current and projected trends in rheumatoid arthritis among postmenopausal women in the U.S.: a population-based analysis of the Global Burden of Disease Study 2021, with projections to 2035.

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with a high prevalence among postmenopausal women (PMW), and it is associated with substantial functional impairment and reduced quality of life. To inform targeted prevention strategies for high-risk populations in the U.S., a comprehensive and up-to-date assessment of disease burden in this population is needed. We conducted a quantitative analysis of the prevalence, years lived with disability (YLDs), and disability-adjusted life years (DALYs) of RA among PMW (PMWRA) in the U.S. from 1990 to 2021. In addition, disease trends were projected for 2022-2035 using data from the Global Burden of Disease Study (GBD) 2021. We extracted state-level estimates of prevalence, YLDs, and DALYs for PMWRA across 51 U.S. states from 1990 to 2021. Temporal trends were summarized using the average annual percent change (AAPC), and geographic and age-specific differences were assessed. Major risk factors contributing to state- and age-specific YLDs and DALYs were analyzed. Future projections were forecast using autoregressive integrated moving average (ARIMA) and exponential smoothing state-space (ETS) models. All analyses were conducted using R version 4.4.2 and the Joinpoint Regression Program. From 1990 to 2021, prevalence, YLD, and DALY rates among U.S. PMWRA showed upward trends, with AAPCs of 0.55, 0.50, and 0.04, respectively; the corresponding total percent changes in numbers were 1.13, 1.10, and 0.82. In 2021, Montana exhibited the highest prevalence (2,235.76), YLD (277.29), and DALY rates (362.62) among all states nationwide. The disease burden increased with the rising sociodemographic index up to a threshold and then declined. Age-stratified analyses indicated increasing prevalence, YLD, and DALY rates across nearly all age groups. Smoking emerged as the principal risk factor for PMWRA-related YLDs and DALYs across ages and regions. Forecasts based on ARIMA and ETS models indicated continued increases in prevalence and YLDs, whereas DALY rates were projected to decline. The burden of PMWRA among U.S. women is projected to continue rising, with concentration in specific states and age groups, which emphasizes the need for targeted public-health interventions to mitigate the burden in this population.