Background/Purpose: Low educational attainment is associated with higher prevalence, morbidity, and mortality of many diseases, including rheumatoid arthritis¹ (RA) and osteoarthritis² (OA). These associations often are attributed to limited access of disadvantaged people to medical services. We studied clinical status of patients with RA or OA, all of whom had access to rheumatology care, at their initial visit.

Methods: All patients seen at an academic rheumatology clinic complete a multidimensional health assessment questionnaire (MDHAQ) at each visit. MDHAQ is a patient self-report questionnaire that includes 3 0-10 scales for physical function (FN), pain (PN), and global assessment (PATGL), compiled into a 0-30 routine assessment of patient index data (RAPID3). We identified 132 new patients with a diagnosis of either RA (n=66) or OA (n=66) seen for an initial visit between May, 2011 and February, 2017, and for whom all data were available. Patient-reported FN, PN, PATGL and RAPID3 were compared in 3 groups according to completed years of schooling, < 12 years, 12 years, and > 12 years, using analysis of variance (ANOVA).

Results: Mean MDHAQ scores were remarkably similar in OA vs RA, and varied similarly according to education level (Table). Mean RAPID3 scores were 15.4 in OA vs and 15.3 in RA patients, 18.2 and 19.8 in OA vs RA patients with <12 years, 15.9 and 16.0 in OA and RA patients with 12 years, and 14.0 and 13.7 in OA vs RA patients with >12 years of education (p=0.11 for OA, p=0.04 for RA) (Table). FN scores were 2.9 for all patients in both OA and RA, 3.9 in both groups for <12, 3.3 in both groups for 12, and 2.3 and 2.4 in OA vs RA patients, respectively, for those with>12 years of education (comparisons by education level p=0.02 for OA, p=0.08 for RA). PN scores were 6.9 and 6.4 in all OA vs RA patients, 7.3 and 8.5 for OA vs RA patients with <12 years, 7.1 and 6.2 for OA vs RA patients with 12 years, and 6.7 and 5.9 for OA vs RA patients with >12 years of education (p=0.69 for OA, p=0.02 for RA). PATGL was 5.6 and 6.0 for all OA vs RA patients, 7.0 and 7.4 for OA vs RA patients with <12 years, 5.5 and 6.5 for OA vs RA patients with 12 years, and 5.1 and 5.4 in OA vs RA patients, with >12 years of education (p=0.14 for OA, p=0.12 for RA).

Table:

Mean & standard deviation (SD) scores for physical function, pain, patient global assessment and RAPID3 of patients with RA or OA at first visit, by formal education level. *p value for differences between education groups by ANOVA

Conclusion: Low education was associated with RAPID3 and all measures both in RA and OA. Differences according to formal education level differed far more than differences by diagnosis, which were negligible. These variations do not appear attributable to differences in access to medical service.

References:

1. J Chronic Dis 1985; 38(12):973-84.

2. J Clin Epidemiol 1992;4 5(2):139-47.

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