Prevalence of rheumatic diseases in Raramuri peopl

Authors: Danyella Del Río Nájera Natalia Santana Ingris PeláezBallestas Susana A GonzálezChávez Celia M QuiñonezFlores César PachecoTena

Publish Date: 2016/03/08

Volume: 35, Issue: 1, Pages: 43-52

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Abstract

This study aimed to determine the prevalence of musculoskeletal MSK pain and rheumatic diseases in the Raramuri population also known as Tarahumaras who are an indigenous group in the northern state of Chihuahua in Mexico We used the CommunityOriented Program for Control of Rheumatic Diseases COPCORD methodology An analytical crosssectional study was conducted including indigenous Raramuri aged ≥18 years from communities settled in Chihuahua City Subjects with positive MSK pain were evaluated by primary care physicians and rheumatologists Demographic and occupational factors such as gender and job type associated with rheumatic disease were investigated A total of 380 indigenous Raramuri mean age 336 ± 131 years 379  male were interviewed Seventysix individuals 20  reported MSK pain in the last 7 days Pain intensity was reported as “severe” and “the most severe” in 30  of the cases Fiftysix individuals 147  reported pain in the past and 86 226  had either past or current pain The prevalence of rheumatic diseases was 105  Diagnosed diseases were osteoarthritis 66  low back pain 16  spondyloarthritis 08  rheumatoid arthritis 05  nonspecific arthritis 05  rheumatic regional pain syndromes 03  and fibromyalgia 03  Rheumatic disease was associated with the following variables age odds ratio OR 104 95  confidence interval CI 102–108 p = 0006 family history of rheumatic symptoms OR 69 95  CI 26–187 p  0001 and Health Assessment QuestionnaireDisability Index OR 289 95  CI 28–2897 p  0001 A high prevalence of nontraumatic MSK pain suggests the need for a rheumatic disease prevention program in the Raramuri people in Chihuahua MexicoRheumatic diseases represent a global problem for both patients and healthcare providers Developing countries are particularly vulnerable because of insufficient and delayed diagnosis of these diseases 1 2 Pain in the musculoskeletal MSK system is characteristic of rheumatic diseases and additionally may lead to disability Individuals suffering from rheumatic disorders have a significant reduction in both their quality of life and life expectancy 3The CommunityOriented Program for Control of Rheumatic Diseases COPCORD was founded by the World Health Organization and International League of Associations for Rheumatology This program emerged as a strategy to define the epidemiologic landscape of rheumatic diseases in developing countries COPCORD provides a screening tool for rheumatic diseases for lowcost community studies 2 4The COPCORD methodology has already been used to assess the prevalence of MSK disorders and rheumatic diseases in Latin American countries 5 6 7 8 9 In Mexico this methodology has been applied in a number of distinct geographic regions 3 10 11 12 13 Previous studies focused mostly on Mexican mestizo populations COPCORD was also applied in more susceptible populations including indigenous groups 7 14 A culturesensitive adaptation and validation of this methodology was performed in Latin American indigenous populations It included Warao Kariña and Chaima Venezuela Mixteco MayaYucateco and Raramuri Mexico and Qom Argentina groups 15Mexico has a multicultural environment that includes many indigenous groups 16 17 The Raramuri people also known as Tarahumaras are a minority indigenous people living in the northern region of Mexico The main location of this group is in the states of Chihuahua Durango and Sonora The Raramuri people living in Chihuahua comprise a group of 158527 people which is almost 5  of the state’s total population 17The Raramuri people are considered as a vulnerable group 18 Their main environment is the “Sierra Tarahumara” which is a rural region composed of mountains canyons and thick forests The terrain is vast and inaccessible resulting in poor Raramuri health status given their very limited or absent access to healthcare facilities 18 19 20 There is a high rate of infant mortality because of infant malnutrition and susceptibility to various infectious diseases 20 Although poor health conditions have been recognized to our knowledge the prevalence of chronic illnesses including MSK disorders and rheumatic diseases has not been reported in the Raramuri indigenous population However it has been found that 37  of this population in Chihuahua State has some kind of physical impairment 17 which could be associated with MSK disorders Detailed information regarding the prevalence of rheumatic diseases could help to create specific prevention programs and also improve healthcare provision in this group Thus the aim of this study was to estimate the prevalence of MSK regional pain syndromes neck shoulder etc and defined rheumatic diseases in Raramuri individuals over 18 years of age living in Chihuahua City as well as to determine the factors associated with the presence of these rheumatic diseasesA crosssectional communitybased study was conducted using the COPCORD methodology The screening tool applied was the COPCORD questionnaire which has been adapted and validated for the Raramuri people 15 The subjects included in the study were aged 18 years or older and belonged to the Raramuri community They were invited to take part in the study and voluntarily gave consent to participate in the surveyThe COPCORD questionnaire 15 included items related to 1 sociodemographic factors 2 comorbidities 3 symptoms pain swelling and stiffness 4 pain characteristics period of time last 7 days or historic pain intensity five options in the Likert scale ranging from none to more severe pain and location and 5 treatment use of conventional and nonconventional medicine Moreover information about disability and work biomechanical loading was collected from the subjects affected by MSK pain using the Health Assessment QuestionnaireDisability Index HAQDI 21 and the mechanical stress dynamic and static questionnaire 22 respectively The mechanical stress questionnaire considers the kind of work that individuals have done throughout their life and identifies the types of positions and movements performed during work Both questionnaires were applied by trained personnel

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