Higher Educational Level Correlates with Retarded Onset and Less Severe Disease in Rheumatoid Arthritis Patients

Michael Zaenker¹, Udo Schwill², Petra Reutermann³, Joachim Listing⁴ and Christel Kordbarlag⁵, ¹Immanuel Klinikum Bernau, Rheumatology Center Northern Brandenburg, Bernau, Germany, ²Internal Medicine Dept., Immanuel Klinikum, Bernau, Germany, ³KMG Elbtal Kliniken, Rheumatology Center Northern Brandenburg, Bad Wilsnack, Germany, ⁴German Rheumatism Research Center, Berlin, Germany, ⁵Ruppiner Kliniken, Rheumatology Center Northern Brandenburg, Neuruppin, Germany

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Education, poverty and rheumatoid arthritis (RA)

Session Information

Title: Epidemiology and Public Health (ACR): Rheumatoid Arthritis Pathogenesis and Treatment

Session Type: Abstract Submissions (ACR)

Background/Purpose

Compared to the general population, patients with RA are endangered by poverty due to treatment-related expenses, disability, unemployment, or early retirement. Additionally, there is impact of poverty on disease management and, still unexplained, increased prevalence of RA is associated with higher mortality in individuals with lower educational level. In this study we evaluate interrelationship between socioeconomic status of RA-patients and their disease severity in an unselected community-based cohort in Northern Brandenburg, Germany.

Methods

Prospective, cross-sectional study among 158 consecutively recruited RA-patients treated in our outpatient-clinic (Bernau) during 3 months. Inclusion criteria were written consent and diagnosis of RA, fulfilling ACR/EULAR-criteria. Using anonymized questionnaires, monthly disposable income, treatment-related expenses and effects of RA on social life were evaluated.

Results

Of all 155 returned questionnaires (return rate 98%), 143 were evaluable. Patient mean age±SD was 60.5±11.7 years, 64% females, mean age at RA-manifestation was 45.5±15.1 years. Monthly median equivalized disposable income (EDI) of RA-patients (1133€, IQR 835-1350) was 86% of the median EDI in the region (1323€), 80% of the median EDI in Germany (1413€). The at-risk-of-poverty-rate (RPR) using the 60% threshold (794 €) of mean EDI of the State Brandenburg was significantly higher compared to the population in the region (22% vs. 14% OR 1.83 p<0.001). Subgroups with different educational levels were equal with regard to mean age and gender. Further comparing subgroups with different educational level, we found in RA-patients with university degree and resulting higher median EDI (1333 IQR 967-1667 vs. 1000 IQR 735-1333 €) a mean age at disease onset that was 10 years higher (53.3 ±10.6 vs. 43.2±15.5 years, p=0.001), less functional limitations (mean FFbH 79.0±26.4 vs. 66.8±27.1%, p=0.043) and a lower rate of early retirement (9.7% vs. 30.4%, p=0.021) than in patients with lower educational level. Additionally, we found trends for lower rate of active smokers (19 vs. 28%, p=0.48) and higher proportion of early treatment within 6 months after disease onset (48 vs. 37%, p=0.30) in the group with university degree. Proportion of patients with biologics was higher in the group with lower educational level (53 vs. 35%, p=0.11), reflecting more severe disease.

Conclusion

Our data support the notion that poverty is not only result of disabling RA but educational level and income themselves may influence disease course. The factors contributing to less severe disease and later manifestation in individuals with higher educational levels are mostly unclear and need more elucidation.

Disclosure:

M. Zaenker,
None;

U. Schwill,
None;

P. Reutermann,
None;

J. Listing,
None;

C. Kordbarlag,
None.

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