Table 3 Summary of content acknowledging prevalence of OA and barriers to OA care by intersectional factors

Prevalence

Older age

(4, 28.5)

[33,34,35,36, 41, 44]

[Osteoarthritis] is more common in middle to older age (prevalence is 35% in those aged 80 years and older)…[33–35 p3]

As the Canadian population ages, OA prevalence is expected to increase and be highest among those over the age of 70 years. In 2010, approximately 49% of seniors over the age of 70 years are expected to be living with symptomatic OA. By 2040, this number is expected to increase to 71% [41 p31]

Gender

(5, 35.7)

[33,34,35,36, 40, 41, 44]

While both men and women get arthritis, two thirds of those affected in Canada are women [40 p9]

Arthritis was reported more frequently by women, older people, and people with lower levels of education and lower incomes. These findings are consistent with other surveys, suggesting that people who have arthritis may have fewer resources to deal with the consequences of this condition. The higher prevalence of arthritis among women also raises questions of whether targeted initiatives are necessary to meet the needs of this sector of the population [44 p35]

Indigenous

(4, 28.5)

[40, 42,43,44]

Chronic disease and risk factor rates tend to be even higher among Indigenous people [42 p4]

Arthritis is up to two-and-a-half times as common in the Indigenous community living off reserve (Public Health Agency of Canada, 2003) as in non-Indigenous Canadians. Overall, 27% of Indigenous people living off reserve have arthritis compared with 16% of the general Canadian population. However, arthritis receives little attention as a significant health issue within the Indigenous community [43 pI]

Socio

economic status

(2, 14.2)

[42, 44]

People with higher levels of education were less likely to report arthritis [44 p22]

Chronic disease becomes more common as people get older. Low incomes, poor social supports, and unhealthy physical environments, also influence the development of chronic disease. These factors combined can contribute to a decreased quality of life for individuals [42 p2]

Barriers

Age

(5, 35.7)

[33,34,35, 49, 40, 43, 44]

Middle-aged and older adults with OA report that their condition has a particularly devastating impact on employment, community mobility, heavy housework, leisure activities, social activities and close relationships

[40 p10]

Canadians who have chronic conditions and who are in fair-to-poor health are more likely than the general public to be poorer, older, less educated, and living in rural areas. Advice to join a gym or eat healthier food may be very challenging for these people to comply with [39 p9]

Gender

(3, 21.4)

[33,34,35, 42, 44]

Patient factors such as age, sex, obesity, comorbidities, etc. should not be barriers to referral for joint surgery [33–35 p46]

Women and people with less education and/or lower income were more likely to have potential unmet need for total joint replacement [44 p107]

Ethno-cultural group

(3, 21.4)

[33,34,35, 34, 39, 40]

Numerous studies have identified difficulties in recruiting certain groups for chronic disease self-management programs (ethnic minorities, indigenous communities, rural residents, older people, and people with low income or lower education) and have raised concern that participation tends to drop off as the course progresses [39 p15]

Specific population groups, such as Indigenous peoples, newcomers, refugees, and the homeless, face barriers in access to care. Factors affecting this lack of access include a lack of programs and self-management resources in different languages, as well as culturally safe care. Some of these population groups are also disproportionately affected by poverty, social isolation, and precarious employment; this, in turn, may impact access to effective osteoarthritis care [34 p3]

Socio

economic status

(7, 50.0)

[32,33,34,35, 39, 40, 42,43,44]

Social, economic, and environmental conditions influence a person’s ability to maintain good health, prevent chronic disease and manage the complications of disease. All determinants of health must be considered to achieve optimal health [42 p6]

One of the challenges for patients navigating conservative treatment is that most of the treatment modalities fall outside of the publicly funded health system. Community educational programs, lifestyle coaching, exercise programs, physiotherapy, massage therapy, and dietary consultations are mostly privately funded. This results in inequity for patients unable or unwilling to fund these treatments out of pocket or who lack adequate private insurance coverage. This situation also leads patients who are financially able to entertain treatment options that are not based on scientific and medical evidence…the result is a complex navigation challenge where patients are forced to become subject matter experts in managing their disease. They are often faced with the difficult choice of paying out of pocket for privately-funded treatments of uncertain benefit, suffering with untreated joint pain until the disease progresses to end-stage, or aggressively pursuing scarce public services, with little guidance or information to assist in their decision-making [32 p6]

Geography

(5, 35.7)

[34, 39, 40, 42, 44]

Barriers to program participation [can include] low literacy, disabilities, transportation costs, distances to services, and access to plain language health [42 p9]

For many, gaining access to the right care and the right provider is a challenge. This is particularly true for people living in rural and remote areas, especially [Indigenous] populations, where distance and transportation costs are additional barriers [40 p22]