Prevalence, comorbidities, and disease-related complications of rheumatoid arthritis in Colombia: a national cross-sectional study based on administrative claims data

Maldonado-Cañón, Kevin; Buitrago, Giancarlo; Quintana-López, Gerardo

doi:10.1186/s42358-025-00437-8

Brazil

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RESEARCH • Adv. rheumatol. 65 • 2025 • https://doi.org/10.1186/s42358-025-00437-8 linkcopy

Prevalence, comorbidities, and disease-related complications of rheumatoid arthritis in Colombia: a national cross-sectional study based on administrative claims data

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background To date, there has been limited exploration, particularly on a national scale, of the prevalence patterns of comorbidities and complications associated with rheumatoid arthritis (RA) in Colombia. We aimed to analyse the prevalence patterns of comorbidities and disease-related complications of RA patients enrolled in Colombia’s contributory healthcare regime.

Methods We performed a nationwide observational descriptive cross-sectional study using administrative claims data. We used a set of sensitive and specific electronic algorithms (i.e., a set of rules) applied to linked data based on ICD-10 codes and unique medication use codes. We compared all those algorithms with several sources, including governmental agencies and scientific literature, to identify all the known adults treated for RA.

Results A total of 123,080 RA cases for 2018 were identified, corresponding to a point prevalence of 0.86 (95% CI 0.86–0.87) per 100. Compared to a non-RA reference population, hypertension (68.2 vs. 20.0%), osteoarthritis (43.6 vs. 6.1%), and osteoporosis (18.6 vs. 1.1%) provided larger standardized mean differences. Lupus (30.04; 95%CI 29.3–30.8), multiple sclerosis (7.18; 95%CI 6.6–7.8), and osteoporosis (5.57; 95%CI 5.5–5.6) provided higher age- and sex-adjusted prevalence ratios. Disease-related complications were found in 62.2% of cases.

Conclusions We describe the first comprehensive assessment of the prevalence patterns of disease-related complications and comorbidities that define the RA burden of disease within a multimorbidity profile. Also, our study provides a narrower and more reliable point prevalence estimate for RA in Colombia.

Keywords
Latin America; Comorbidity; Complications; Prevalence; Rheumatoid arthritis

	Number of RA cases	Total population	Prevalence per 100 (95% CI)
Sex
Female	101,105 (82.1%)	7,496,953	1.35 (1.34–1.36)
Male	21,975 (17.9%)	6,746,654	0.33 (0.32–0.33)
Age Group
18–34	11,137 (9.0%)	5,375,484	0.21 (0.20–0.21)
35–44	14,399 (11.7%)	2,822,459	0.51 (0.50–0.52)
45–54	26,099 (21.2%)	2,336,645	1.12 (1.10–1.13)
55–64	33,550 (27.3%)	1,889,023	1.78 (1.76–1.80)
65–74	23,751 (19.3%)	1,102,856	2.15 (2.13–2.18)
≥ 75	14,144 (11.5%)	717,140	1.97 (1.94–2.01)
Region
Atlántica	13,702 (11.1%)	1,753,202	0.78 (0.77–0.80)
Bogotá	39,846 (32.4%)	4,376,279	0.91 (0.90–0.92)
Central	33,698 (27.4%)	5,084,180	0.66 (0.66–0.67)
Oriental	16,461 (13.4%)	1,006,125	1.64 (1.61–1.66)
Orinoquía - Amazonía	677 (0.6%)	130,809	0.52 (0.48–0.56)
Pacífica	18,696 (15.2%)	1,893,012	0.99 (0.97–1.00)
Overall	123,080 (100%)	14,243,607	0.86 (0.86–0.87)

Variables	RA cases (n = 123,080)		Non-RA population (n = 14,120,527)		SMD
Variables	n	Prevalence per 100 (95% CI)	n	Prevalence per 100 (95% CI)	SMD
Neoplasms
Colorectal Neoplasms	1158	0.94 (0.89–1.00)	32,942	0.23 (0.23–0.24)	0.09
Lung Neoplasms	406	0.33 (0.30–0.36)	8719	0.06 (0.06–0.06)	0.06
Skin Neoplasms	3,67	2.98 (2.89–3.07)	116,641	0.83 (0.82–0.83)	0.16
Endocrine
Hypothyroidism	35,864	29.14 (28.89–29.39)	945,82	6.70 (6.68–6.71)	0.61
Diabetes	25,311	20.56 (20.34–20.79)	815,064	5.77 (5.76–5.78)	0.45
Psychiatric
Depression	11,344	9.22 (9.06–9.38)	280,101	1.98 (1.98–1.99)	0.32
Anxiety	13,853	11.26 (11.08–11.43)	461,292	3.27 (3.26–3.28)	0.31
Neurologic
Parkinson’s Disease	889	0.72 (0.68–0.77)	27,142	0.19 (0.19–0.19)	0.08
Multiple Sclerosis	633	0.51 (0.48–0.56)	5,539	0.04 (0.04–0.04)	0.09
Migraine	13,169	10.70 (10.53–10.87)	961,921	6.81 (6.80–6.83)	0.14
Cardiovascular
Hyperlipidemia	27,278	22.16 (21.93–22.39)	1,332,862	9.44 (9.42–9.46)	0.35
Hypertension	83,946	68.20 (67.95–68.46)	2,829,972	20.04 (20.02–20.07)	1.11
Angina	3838	3.12 (3.03–3.21)	120,758	0.86 (0.85–0.86)	0.16
Acute Myocardial Infarction	4502	3.66 (3.56–3.76)	96,086	0.68 (0.68–0.68)	0.21
Coronary Artery Disease	6609	5.37 (5.25–5.49)	210,288	1.49 (1.48–1.50)	0.21
Arrhythmias	5402	4.39 (4.28–4.50)	184,046	1.30 (1.30–1.31)	0.19
Heart Failure	4155	3.38 (3.28–3.48)	105,069	0.74 (0.74–0.75)	0.19
Stroke	1181	0.96 (0.91–1.01)	34,124	0.24 (0.24–0.24)	0.09
Pulmonary
Chronic Sinusitis	4269	3.47 (3.37–3.57)	146,947	1.04 (1.04–1.05)	0.16
Chronic Bronchitis	2636	2.14 (2.06–2.22)	76,774	0.54 (0.54–0.55)	0.14
Emphysema	237	0.19 (0.17–0.22)	4711	0.03 (0.03–0.03)	0.05
COPD	13,294	10.80 (10.63–10.98)	288,22	2.04 (2.03–2.05)	0.36
Asthma	6621	5.38 (5.26–5.50)	239,95	1.70 (1.69–1.71)	0.20
Gastrointestinal
GERD	11,989	9.74 (9.58–9.91)	388,125	2.75 (2.74–2.76)	0.29
Gastric Ulcer	756	0.61 (0.57–0.66)	18,022	0.13 (0.13–0.13)	0.08
Gastritis	41,222	33.49 (33.24–33.75)	1,582,287	11.21 (11.19–11.22)	0.56
Inflammatory Bowel Disease	5734	4.66 (4.55–4.77)	341,262	2.42 (2.41–2.42)	0.12
Diverticulitis	2112	1.72 (1.65–1.79)	45,614	0.32 (0.32–0.33)	0.14
Skin
Eczema	20,959	17.03 (16.82–17.24)	997,176	7.06 (7.05–7.08)	0.31
Psoriasis	3139	2.55 (2.47–2.64)	46,162	0.33 (0.32–0.33)	0.19
Sebaceous Gland Disorders	1,887	1.53 (1.47–1.60)	201,667	1.43 (1.42–1.43)	0.01
Musculoskeletal
Osteoarthritis	53,714	43.64 (43.37–43.91)	859,675	6.09 (6.08–6.10)	0.96
Lupus	10,686	8.68 (8.53–8.84)	24,767	0.18 (0.17–0.18)	0.42
Discopathy	16,282	13.23 (13.04–13.42)	489,892	3.47 (3.46–3.48)	0.36
Osteoporosis	22,868	18.58 (18.37–18.79)	151,697	1.07 (1.07–1.08)	0.62
Urogenital
Urolithiasis	8686	7.06 (6.92–7.19)	569,134	4.03 (4.02–4.04)	0.13
Cystitis	6596	5.36 (5.24–5.48)	313,821	2.22 (2.21–2.23)	0.16

Comorbidities	PR (95% CI)	Age- and sex-adjusted PR (95% CI)
Neoplasms
Colorectal Neoplasms	3.09 (2.91–3.27)	1.90 (1.79–2.01)
Lung Neoplasms	4.09 (3.7–4.52)	2.38 (2.15–2.63)
Skin Neoplasms	2.76 (2.67–2.85)	1.68 (1.63–1.74)
Endocrine
Hypothyroidism	3.33 (3.3–3.36)	1.94 (1.92–1.96)
Diabetes	2.73 (2.7–2.76)	1.64 (1.62–1.65)
Psychiatric
Depression	3.56 (3.49–3.62)	2.39 (2.35–2.43)
Anxiety	2.64 (2.6–2.68)	1.82 (1.79–1.85)
Neurologic
Parkinson’s Disease	2.88 (2.69–3.07)	1.70 (1.59–1.82)
Multiple Sclerosis	10.04 (9.24–10.89)	7.18 (6.6–7.82)
Migraine	1.20 (1.18–1.22)	1.27 (1.25–1.29)
Cardiovascular
Hyperlipidemia	1.80 (1.78–1.82)	1.21 (1.2–1.22)
Hypertension	2.60 (2.59–2.62)	1.61 (1.6–1.62)
Angina	2.79 (2.7–2.88)	1.76 (1.7–1.82)
Acute Myocardial Infarction	4.11 (4-4.24)	2.79 (2.7–2.87)
Coronary Artery Disease	2.76 (2.69–2.83)	1.78 (1.74–1.82)
Arrhythmias	2.58 (2.51–2.65)	1.55 (1.51–1.59)
Heart Failure	3.47 (3.37–3.58)	2.02 (1.96–2.08)
Stroke	3.04 (2.87–3.22)	1.80 (1.7–1.91)
Pulmonary
Chronic Sinusitis	2.55 (2.48–2.63)	2.00 (1.94–2.06)
Chronic Bronchitis	3.02 (2.9–3.13)	1.77 (1.71–1.84)
Emphysema	4.42 (3.88–5.03)	2.78 (2.44–3.17)
COPD	4.05 (3.98–4.12)	2.24 (2.2–2.27)
Asthma	2.42 (2.37–2.48)	1.88 (1.84–1.93)
Gastrointestinal
GERD	2.71 (2.67–2.76)	1.89 (1.85–1.92)
Gastric Ulcer	3.68 (3.43–3.96)	2.47 (2.3–2.66)
Gastritis	2.29 (2.27–2.31)	1.76 (1.75–1.78)
Inflammatory Bowel Disease	1.48 (1.44–1.51)	1.54 (1.5–1.58)
Diverticulitis	4.07 (3.89–4.25)	2.18 (2.08–2.27)
Skin
Eczema	1.85 (1.82–1.87)	1.62 (1.6–1.64)
Psoriasis	5.97 (5.76–6.19)	5.04 (4.86–5.23)
Sebaceous Gland Disorders	0.82 (0.79–0.86)	1.79 (1.71–1.87)
Musculoskeletal
Osteoarthritis	5.49 (5.45–5.52)	2.83 (2.81–2.86)
Lupus	37.89 (37.06–38.73)	30.04 (29.29–30.82)
Discopathy	2.92 (2.88–2.96)	2.07 (2.04–2.1)
Osteoporosis	13.24 (13.07–13.41)	5.57 (5.5–5.64)
Urogenital
Urolithiasis	1.34 (1.31–1.37)	1.43 (1.4–1.46)
Cystitis	1.85 (1.8–1.89)	1.36 (1.33–1.39)

Variables	Age group				Sex		Total
Variables	18–49 (n = 33,624)	50–64 (n = 48,580)	65–74 (n = 24,964)	≥ 75 (n = 15,912)	Female (n = 101,105)	Male (n = 21,975)	Total
Infectious complications
Viral and bacterial pneumonia	5.91 (5.66–6.18)	8.71 (8.46–8.96)	12.85 (12.44–13.28)	19.40 (18.79–20.02)	9.97 (9.80–10.15)	11.07 (10.65–11.50)	10.17 (10.00–10.34)
Urinary tract infection	7.77 (7.48–8.06)	8.05 (7.80–8.30)	8.22 (7.87–8.58)	7.77 (7.35–8.21)	9.10 (8.93–9.27)	2.78 (2.57–3.01)	7.97 (7.83–8.12)
Central nervous system infection	0.53 (0.46–0.61)	0.53 (0.47–0.60)	0.66 (0.57–0.77)	0.58 (0.47–0.72)	0.54 (0.50–0.59)	0.67 (0.57–0.79)	0.56 (0.52–0.61)
Skin and subcutaneous tissue infections	19.70 (19.29–20.12)	21.35 (20.98–21.72)	21.61 (21.10–22.13)	23.15 (22.49–23.82)	20.95 (20.72–21.19)	22.25 (21.68–22.82)	21.18 (20.96–21.41)
Intestinal infectious diseases	41.44 (40.91–41.97)	33.36 (32.94–33.79)	31.15 (30.58–31.73)	31.81 (31.10–32.54)	35.34 (35.06–35.61)	33.01 (32.39–33.64)	34.92 (34.66–35.18)
Tuberculosis	2.61 (2.44–2.79)	2.98 (2.83–3.13)	2.49 (2.31–2.69)	2.06 (1.85–2.30)	2.45 (2.36–2.55)	3.62 (3.39–3.87)	2.66 (2.57–2.75)
Other bacterial diseases	0.79 (0.69–0.89)	0.74 (0.66–0.82)	0.77 (0.67–0.89)	0.88 (0.74–1.04)	0.75 (0.70–0.80)	0.91 (0.79–1.04)	0.78 (0.73–0.82)
Sexually transmitted infections	4.04 (3.83–4.26)	2.05 (1.92–2.18)	1.58 (1.43–1.74)	1.41 (1.24–1.61)	2.20 (2.12–2.29)	3.38 (3.15–3.62)	2.41 (2.33–2.50)
Viral infections	15.41 (15.01–15.81)	16.55 (16.21–16.89)	16.76 (16.30–17.23)	15.02 (14.46–15.60)	16.29 (16.08–16.51)	15.11 (14.63–15.60)	16.08 (15.88–16.29)
Viral hepatitis	1.73 (1.59–1.88)	1.58 (1.48–1.69)	1.38 (1.24–1.53)	0.90 (0.77–1.07)	1.40 (1.33–1.47)	1.93 (1.75–2.13)	1.49 (1.43–1.56)
Acute myocardial infarction	0.10 (0.07–0.14)	0.35 (0.30–0.40)	0.80 (0.69–0.92)	1.14 (0.98–1.32)	0.35 (0.31–0.39)	1.04 (0.91–1.19)	0.47 (0.44–0.51)
Musculoskeletal complications
Total Hip Replacement	0.23 (0.18–0.28)	0.54 (0.47–0.60)	0.79 (0.69–0.92)	0.99 (0.85–1.16)	0.55 (0.51–0.60)	0.62 (0.53–0.74)	0.56 (0.52–0.60)
Total Knee Replacement	0.15 (0.11–0.20)	0.83 (0.75–0.91)	1.65 (1.50–1.82)	1.65 (1.47–1.86)	0.92 (0.86–0.98)	0.91 (0.80–1.05)	0.92 (0.87–0.97)
Ankle Joint Replacement	0.00 (0.00–0.02)	0.01 (0.00–0.02)	0.02 (0.01–0.05)	-	0.01 (0.00–0.02)	0.01 (0.00–0.04)	0.01 (0.01–0.02)
Elbow Joint Replacement	0.02 (0.01–0.04)	0.08 (0.06–0.10)	0.09 (0.06–0.14)	0.04 (0.02–0.09)	0.06 (0.04–0.07)	0.07 (0.04–0.12)	0.06 (0.05–0.07)
Shoulder Joint Replacement	0.01 (0.01–0.03)	0.08 (0.06–0.11)	0.26 (0.21–0.34)	0.42 (0.33–0.54)	0.16 (0.13–0.18)	0.09 (0.06–0.14)	0.14 (0.12–0.17)
Comorbidities
Hypertension	49.92 (49.39–50.45)	65.92 (65.49–66.35)	82.44 (81.96–82.91)	91.48 (91.03–91.91)	67.91 (67.63–68.19)	69.55 (68.94–70.16)	68.20 (67.95–68.46)
Osteoarthritis	19.50 (19.09–19.92)	46.66 (46.21–47.11)	58.88 (58.27–59.49)	61.53 (60.79–62.26)	45.70 (45.41–46.00)	34.17 (33.54–34.80)	43.64 (43.37–43.91)
Gastritis	25.36 (24.91–25.81)	34.73 (34.31–35.16)	38.95 (38.35–39.56)	38.32 (37.58–39.07)	34.87 (34.59–35.14)	27.17 (26.58–27.76)	33.49 (33.24–33.75)
Hypothyroidism	22.88 (22.45–23.32)	27.91 (27.51–28.31)	35.01 (34.43–35.60)	36.91 (36.17–37.65)	31.21 (30.93–31.48)	19.62 (19.08–20.17)	29.14 (28.89–29.39)
Hyperlipidemia	8.71 (8.41–9.03)	26.36 (25.98–26.75)	30.45 (29.88–31.02)	24.77 (24.10–25.45)	22.32 (22.08–22.57)	21.43 (20.88–22.00)	22.16 (21.93–22.39)
Diabetes	7.46 (7.18–7.75)	19.46 (19.11–19.83)	30.17 (29.60–30.74)	36.56 (35.82–37.30)	20.22 (19.99–20.45)	22.14 (21.58–22.72)	20.56 (20.34–20.79)
Osteoporosis	2.94 (2.76–3.14)	15.38 (15.06–15.72)	32.59 (32.01–33.17)	39.40 (38.67–40.14)	21.09 (20.85–21.32)	7.05 (6.72–7.39)	18.58 (18.37–18.79)
Eczema	15.44 (15.05–15.85)	17.36 (17.02–17.71)	18.16 (17.69–18.64)	17.58 (17.00–18.19)	17.44 (17.22–17.66)	15.15 (14.67–15.65)	17.03 (16.82–17.24)
Discopathy	8.99 (8.68–9.31)	14.82 (14.50–15.15)	15.38 (14.94–15.83)	13.96 (13.41–14.53)	13.18 (12.99–13.38)	13.43 (12.98–13.90)	13.23 (13.04–13.42)
Anxiety	9.03 (8.72–9.35)	12.64 (12.34–12.94)	11.78 (11.39–12.20)	10.91 (10.42–11.42)	12.13 (11.94–12.32)	7.23 (6.89–7.57)	11.26 (11.08–11.43)
COPD	2.46 (2.30–2.64)	6.87 (6.65–7.10)	16.47 (16.02–16.94)	31.52 (30.81–32.24)	10.02 (9.85–10.20)	14.39 (13.92–14.87)	10.80 (10.63–10.98)
Migraine	17.30 (16.90–17.71)	11.14 (10.86–11.43)	5.67 (5.38–5.97)	3.30 (3.03–3.59)	12.03 (11.84–12.23)	4.56 (4.31–4.83)	10.70 (10.53–10.87)
GERD	5.57 (5.33–5.82)	10.95 (10.68–11.24)	12.29 (11.88–12.71)	10.86 (10.37–11.37)	10.29 (10.11–10.47)	7.21 (6.88–7.55)	9.74 (9.58–9.91)
Depression	7.86 (7.57–8.16)	10.04 (9.78–10.31)	9.09 (8.72–9.46)	9.77 (9.30–10.26)	9.79 (9.62–9.97)	6.56 (6.25–6.89)	9.22 (9.06–9.38)
Lupus	14.15 (13.78–14.54)	8.44 (8.20–8.69)	5.30 (5.03–5.60)	3.15 (2.89–3.44)	9.50 (9.33–9.68)	4.91 (4.65–5.19)	8.68 (8.53–8.84)

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[TFN1] CI: Confidence Interval; COPD: Chronic Obstructive Pulmonary Disease; GERD: Gastroesophageal Reflux Disease; RA: rheumatoid arthritis; SMD: Standardized mean differences. The bolded SMD values denote systematic differences between the two cohorts (SMD > 0.2)