Association of Socioeconomic Status With Treatment Delays, Disease Activity, Joint Damage, and Disability in Rheumatoid Arthritis

Abstract

Objective To examine the association of socioeconomic status (SES) and delays in DMARD treatment with clinical measures in rheumatoid arthritis (RA) patients. Methods RA patients were recruited from rheumatology clinics. We assessed SES based on education, occupation and income and divided patients into tertiles. The time from RA symptom onset to DMARD initiation (DMARD lag) was determined by self-report of the two dates, and distance to the rheumatologist (Distance) was obtained from Google Maps. We examined disease activity, determined by DAS28ESR, joint damage, determined from hand radiographs by Sharp scores, and physical disability, determined by the Modified Health Assessment Questionnaire (MHAQ). We used linear regression models to examine the relationship between clinical measures and SES, Distance, and DMARD lag. Results We recruited 1,209 RA patients, 1159 of whom had received DMARD treatment. Average ± SD DMARD lag was 6.9 ± 9.0 years. On average, patients with lower SES waited 8.5 ± 10.2 years after onset of RA symptoms to begin DMARD treatment, compared to those in middle and upper SES tertiles who waited 6.1 ± 7.9 years (P=0.002) and 6.1 ± 8.6 years (P=0.009), respectively. Each year of delayed treatment was associated with a DAS28ESR increase of 0.02 (P≤0.001), a Sharp score increase of 1.33 (P≤0.001) and MHAQ score increase of 0.01 (P≤0.001). Conclusion Low SES was associated with delay in DMARD initiation, and both were independently associated with worse clinical measures in RA. Strategies to reduce treatment delay in low SES RA patients are needed.

Treatment delays for patients with new‐onset rheumatoid arthritis presenting to an Australian early arthritis clinic

“…When DAS28 was excluded from analysis, key aspects of its components (TJC, SJC and patient disease activity VAS) approached but did not independently reach statistical significance (data not shown). Relative socioeconomic disadvantage was additionally associated with longer patient delay in this study, similar to previous findings, despite universal healthcare access in Australia . Previous studies provide insight into how SES may impact health‐seeking behaviour, with low levels of health literacy affecting the ability of patients to assess appropriately new symptoms and seek help promptly .…”

“…Relative socioeconomic disadvantage was additionally associated with longer patient delay in this study, similar to previous findings, despite universal healthcare access in Australia. 18,26 ACPA, anti-citrullinated peptide antibody; CRP, C-reactive protein; DAS28, 28-joint disease activity score; ESR, erythrocyte sedimentation rate; mHAQ, modified health assessment questionnaire; PGA, physician global assessment; RF, rheumatoid factor; SD, standard deviation; SJC, swollen joint count; TJC, tender joint count, VAS, visual analogue score. Previous studies provide insight into how SES may impact health-seeking behaviour, with low levels of health literacy affecting the ability of patients to assess appropriately new symptoms and seek help promptly.…”

Factors associated with hand joint destruction in Chinese patients with rheumatoid arthritis

“…This differences might be explained that certain patients with comorbidities were excluded in this study. Additionally, it is well known that SES is multifactor (e.g., education, income) and low SES could result in joint destruction in RA patients [9]. Our study also demonstrated that there were significant correlation between low education level and hand joint destruction.…”

Use of complementary and alternative medicines is associated with delay to initiation of disease‐modifying anti‐rheumatic drug therapy in early inflammatory arthritis

“…While this is more than the recommended 12 weeks, it compares favorably with other early arthritis cohorts in developed countries and is much shorter than that reported in developing countries . Previous studies have suggested lower socioeconomic status (SES), lower number of swollen joints, seropositivity and presence of other comorbid conditions such as fibromyalgia and osteoarthritis to be associated with delayed presentation . In our study, education level and being non‐English speaking were used as surrogates for SES; however, these were not associated with increased delay to DMARD prescription.…”