Association of functional outcome with both personal‐ and area‐level socioeconomic inequalities in patients with inflammatory polyarthritis

Abstract

ObjectiveTo describe the relationship between baseline area- and person-level social inequalities and functional disability at 3 years in patients with early inflammatory polyarthritis (IP).MethodsA total of 1,393 patients with new-onset IP were recruited and allocated an Index of Multiple Deprivation (IMD) 2004 score based on their area of residence, and a social class based on baseline self-reported occupation. Differences in the Health Assessment Questionnaire (HAQ) score at baseline and 3 years by IMD or social class were tested. The mean 3-year change in HAQ score was compared by IMD and social class, and interactions between these measures examined.ResultsPatients from more deprived areas had poorer 3-year HAQ outcome than those from less deprived areas (P = 0.019, adjusted for baseline HAQ score, age, sex, and symptom duration). The mean difference in HAQ change was most notable between the most deprived (IMD4) and least deprived areas (IMD1) (0.22; 95% confidence interval [95% CI] 0.11, 0.34). There was also a significant difference in HAQ score change between patients of the highest (SCI and II) and lowest social class (SCIV and V) (0.11; 95% CI 0.02, 0.20). For the mean (95% CI) 3-year change in HAQ score, a significant interaction exists between IMD score and social class and their association with HAQ scores (P = 0.001) to modify outcome: IMD1/SC I and II −0.23 (95% CI −0.40, −0.06) versus IMD 4/SC IV and V 0.15 (95% CI −0.05, 0.34).ConclusionPerson- and area-level inequalities combine to modify outcome for rheumatoid arthritis. A person's social circumstance and residential environment have independent effects on outcome and are not just alternative measures of the same exposure.

The Association Between Low Socioeconomic Status With High Physical Limitations and Low Illness Self‐Perception in Patients With Juvenile Idiopathic Arthritis: Results From the Childhood Arthritis Prospective Study

“…In this study we used area deprivation level data, which conceptually might be slightly different. SES levels measured at an individual level and at an area level have both shown to be independent predictors of arthritis health 12. A disadvantage of using individual‐level data in this study might have been that the data will reflect the parent's SES.…”

“…In addition to differences in individual backgrounds, people are also affected by their environment and the opportunities to live in certain areas (i.e., deprivation at an area level). Although these concepts of measuring SES differ slightly, they have both shown to exhibit independent effects on outcome in arthritis and are used interchangeably, and thus are both referred to as SES in this article 12. In populations including patients with adult rheumatoid arthritis, those from deprived areas have more severe disease activity early in the course of the disease and have worse disease progression over time 13, 14, 15, but conflicting results have been found with respect to access to health care 16.…”

What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review

“…A large proportion of screened articles was not included in this review because of not fulfilling the inclusion criteria. Some studies investigated patients with early (poly)arthritis, but not specifically RA, and were, therefore, not included 31 32. Several of the excluded studies did show that patients with RA with shorter symptom duration had a better outcome.…”

Relationship between area-level socio-economic deprivation and autoantibody status in patients with rheumatoid arthritis: multicentre cross-sectional study

“…Socio-economic deprivation is known to be associated with an adverse prognosis in RA,14–16 as in many other diseases 17. Smoking is one of a complex set of inter-related factors related to deprivation.…”