Does Socioeconomic Status Affect Outcomes In Early Rheumatoid Arthritis? Data From An Inception Cohort

Grace Yang¹, Vivian P. Bykerk², J. Carter Thorne³, Gilles Boire⁴, Diane Tin⁵, Carol A. Hitchon⁶, Edward Keystone⁷, Boulos Haraoui⁸ and Janet E. Pope⁹, ¹Medicine, Western University of Canada, London, ON, Canada, ²Medicine, Mount Sinai Hospital/University of Toronto, Toronto, ON, Canada, ³Southlake Regional Health Centre, Newmarket, ON, Canada, ⁴Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada, ⁵The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, ⁶Rheumatology, University of Manitoba, Winnipeg, MB, Canada, ⁷Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, University of Toronto, Toronto, ON, Canada, ⁸Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada, ⁹St Joseph Health Care, London, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Education, Health Assessment Questionnaire, remission, rheumatoid arthritis (RA) and socioeconomic status

Session Information

Title: Rheumatoid Arthritis-Clinical Aspects III: Outcome Measures, Socioeconomy, Screening, Biomarkers in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Assess the impact of socioeconomic status (SES) on outcomes in patients with early inflammatory arthritis using data from the Canadian Early Arthritis Cohort (CATCH) study.

Methods: 2023 patients were recruited into a prospective cohort study, and allocated to low- or high-SES groups based on education and income. Outcomes at baseline and 12 months analyzed against SES include the Disease Activity Score (DAS28), pain, patient global assessment scale, the Health Assessment Questionnaire Disability Index (HAQ), and the SF12-v2 Health Survey. Correlations and regression analyses were performed.

Results: Forty-four % had education of high school or less and 38% were in the lowest income group (<$50,000/year). The low-education group presented with higher DAS28 (p=0.045) at baseline; DAS28 and education were not correlated at 12 months. Low education was also associated with lower physical component score on SF12-v2 at baseline (p=0.018) and 12 months (p=0.024). Patients from the low-income group presented with higher HAQ (p=0.017), pain (p=0.035), patient global assessment (p=0.004), and Simplified Disease Activity Index (SDAI) (p=0.022). Comparing baseline low to high income groups was associated with an odds ratio (OR) for above-median: HAQ 1.220 (95% CI 1.013-1.470), patient global assessment 1.284 (95% CI 1.067-1.546), and SDAI 1.240 (95% CI 1.018-1.509). The predictive value of low income for HAQ remained at 12 months, OR 1.304 (95% CI 1.018-1.669) but the other variables were non-significant.

Conclusion:

Low SES is associated at baseline with higher disease activity, poorer physical function, more pain, higher patient global assessment, and higher HAQ. Physical function and HAQ remain worse at one-year follow-up. This could be due to an effect of SES on health related behaviors or confounding (such as older patients having lower SES and more comorbidities).

Disclosure:

G. Yang,
None;

V. P. Bykerk,
None;

J. C. Thorne,
None;

G. Boire,
None;

D. Tin,
None;

C. A. Hitchon,
None;

E. Keystone,
None;

B. Haraoui,
None;

J. E. Pope,
None.

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