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Abstract Number: 1905

Lower Education Level Is Associated with Higher Risk of Developing Rheumatoid Arthritis

Paola de Pablo1, Dora Romaguera2, Salvatore Panico3, Amalia Mattiello3, Diana Gavrila4, Carmen Navarro4, Carlotta Sacerdote5, Paolo Vineis6, Rosario Tumino7, William Ollier8, Elio Riboli6, Patrick Venables9 and Benjamin Fisher10, 1University of Birmingham, Birmingham, United Kingdom, 2CIBER-OBN (Fisiopatología de la Obesidad y Nutrición), University Hospital Son Espases, Palma, Spain, 3Federico II University of Naples, Naples, Italy, 4Murcia Regional Health Council, Murcia, Spain, 5Città della Salute e della Scienza University-Hospital, Turin, Italy, 6Imperial College London, London, United Kingdom, 7"Civic - M.P.Arezzo" Hospital, Ragusa, Italy, 8Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom, 9Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom, 10Rheumatology, University of Birmingham, Birmingham, United Kingdom

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Education, Rheumatoid arthritis (RA), risk and socioeconomic factors

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Session Information

Date: Monday, October 22, 2018

Session Title: 4M101 ACR Abstract: Epidemiology & Pub Health II: RA Risk: Education, Obesity, Smoking, or Biomarkers? (1905–1910)

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Lower socio-economic status (SES) has been associated with worse clinical outcomes, reduced functional ability and lower quality of life; however, little is known about the association between SES and the development of RA. A few studies have observed an inverse association between education level, a surrogate marker of SES, and risk of developing RA in Northern European populations. The purpose was to investigate the association between SES on an individual level and risk of developing RA in a Southern European Mediterranean population.

Methods: EPIC is a multicentre, pan-European prospective cohort study of apparently healthy populations. We undertook a nested case-control study to investigate risk factors for RA, by identifying incident RA cases (pre-RA) and matched controls amongst subjects enrolled in four EPIC cohorts in Italy and Spain. The lifestyle, environmental exposure, anthropometric information and blood samples were collected at baseline. Confirmed pre-RA cases were matched with controls by age, sex, centre, and date, time and fasting status at blood collection. The exposure was SES as measured by level of educational attainment categorised as university (referent), secondary school/technical/professional school, primary school completed, and none. The primary outcome was incident RA. Conditional logistic regression (CLR) analysis was adjusted for ACPA seropositivity, smoking status, and presence of shared epitope (SE). A further model also adjusted for other potential confounders, including body mass index (BMI), waist circumference, physical activity, and alcohol intake.

Results: The study sample included 398 individuals of which 99 individuals went on to subsequently develop RA. In this analysis, time to diagnosis (defined as time between date of blood sample and date of diagnosis), was 6.71 years (SD 3.43). A significant positive association was observed with level of educational attainment and RA incidence (secondary/technical vs university: OR 5.60, 95% CI 1.59-19.7, primary school vs university: OR 5.06, 95% CI 1.45-17.6, no education vs university: 7.11, 95% CI 1.37-36.8; p for trend 0.02) independent of ACPA seropositivity, SE and smoking). This association between level of educational attainment and RA incidence was confirmed in the fully adjusted model (secondary/technical vs university: OR 5.52, 95% CI 1.53-19.9, primary school vs university: OR 4.87, 95% CI 1.38-17.1, no education vs university: OR 6.48, 95% CI 1.21-34.6; p for trend 0.02).

Conclusion: Lower educational levels were associated with higher risk of developing RA in a Southern European Mediterranean population. This association was not explained by other established genetic and environmental risk factors for RA.


Disclosure: P. de Pablo, None; D. Romaguera, None; S. Panico, None; A. Mattiello, None; D. Gavrila, None; C. Navarro, None; C. Sacerdote, None; P. Vineis, None; R. Tumino, None; W. Ollier, None; E. Riboli, None; P. Venables, None; B. Fisher, None.

To cite this abstract in AMA style:

de Pablo P, Romaguera D, Panico S, Mattiello A, Gavrila D, Navarro C, Sacerdote C, Vineis P, Tumino R, Ollier W, Riboli E, Venables P, Fisher B. Lower Education Level Is Associated with Higher Risk of Developing Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/lower-education-level-is-associated-with-higher-risk-of-developing-rheumatoid-arthritis/. Accessed January 27, 2023.
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