Background/Purpose: The relationship between social determinants of health (SDH) (e.g. income, education, and employment status) and disease outcomes in the RA population is not well documented. We aimed to understand the effect of different SDH on disease activity and functional ability.

Methods: All retrospective data were extracted from the Ontario Best Practices Research Initiative- Rheumatoid Arthritis (OBRI-RA) registry for the period January 2008 to April 2022. We conducted adjusted generalized linear mixed models analysis to investigate the effect of baseline SDH on disease activity, using the Clinical disease activity index (CDAI), and functional disability, using the Health Assessment Questionnaire-disability index (HAQ-DI) at 12 months follow-up. The analysis was completed on multiple imputed.

Results: Two thousand six hundred fifty-one patients were identified with a mean (SD) age of 58.1 years (12.9) and 77.8% were female.

Retired patients (compared to unemployed) had higher improvement (difference =-1.62; 95%CI: –3.11,-0.14)and current smokers (compared to never/past) had lower improvement (difference =0.95; 95%CI: -0.02, 1.92)in disease activity (CDAI) at 12 months.

CDAI LDA/remission was less common current smokers (adj ORs: 0.82; 95%CI: 0.68, 0.99) and more common in females (adj ORs: 1.33; 95%CI: 1.12, 1.58).

Compared to unemployed, employed (difference =-0.24; 95%CI: -0.32,-0.16) or retired patients (difference =-0.16; 95%CI: -0.25,-0.07), those with higher house hold income ( >50 vs. ≤ 50 CAD) (difference =-0.10; 95%CI: -0.16, -0.04), and post-secondary education (compared to high school or less) (difference =-0.07; 95%CI: -0.11, -0.02) had greater improvement of physical function (Table 1). Caucasian race (compared to non-Caucasian) and alcohol consumption (compared to never use) were also associated with a positive impact on functional ability. In contrast, currently smokers (compared to never/past) had lower improvements in physical function (difference= 0.08; 95%CI: 0.01, 0.14).

Conclusion: Our study suggests that disease activity and functional disability are affected by different SDH factors at 12 months follow-up. These differences in SDH must be understood and addressed by rheumatologists to provide equitable healthcare for all patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/functional-disability-and-disease-activity-are-affected-by-social-determinants-of-health-in-patients-with-rheumatoid-arthritis/