Session Information
Title: Epidemiology and Public Health (ACR): Rheumatoid Arthritis and Systemic Lupus Erythematosus Outcomes
Session Type: Abstract Submissions (ACR)
Background/Purpose
Inequalities in health between low and high income countries are often reported, but it is not known whether clinical disease activity measures (“objective”) and person reported outcomes (“subjective”) follow the same patterns in patients with rheumatoid arthritis (RA). The objective of this study was to investigate the patterns in RA health outcomes (“objective” vs “subjective” outcomes) across countries with different level of socio-economic development.
Methods
Data from a cross-sectional multinational (17 countries) study COMORA was used. Contribution of gross domestic product (GDP) to clinical disease activity measures (DAS28, total joint count (TJC), swollen joint count (SJC), and erythrocyte sedimentation rate (ESR)) and person reported outcomes (Patient global assessment (PatGA) (0-10), fatigue (0-10), Physician global assessment (PhysGA) (0-10) and function assessed with health assessment questionnaire (HAQ) (0-3)) was explored. All models were adjusted for potentially relevant confounders, including age, gender, education and comorbidities (Wolfe-Michaud index). Models were computed with and without adjustment for current RA medication (steroids, NSAIDs and DMARDs). Additionally, models with person reported outcomes were adjusted for the presence of erosive disease, TJC, SJC, and ESR. GDP was dichotomized in low and high GDP countries (with a cut-off of 20,000 international dollars per capita (adjusted to purchasing power parity), which by data inspection was the one that discriminated best both groups).
Results
A total of 3920 RA patients from 17 countries (range 30-411) were included in COMORA (mean age 56 y.o. (SD13), 82% females). DAS28 varied between 5.3 (Egypt) and 2.6 (Netherlands), HAQ ranged between 0.7 (Taiwan) and 1.5 (Netherlands). Venezuela had the lowest average score on fatigue (1.7) and Netherlands scored on average highest on fatigue (5.0). In models adjusted for medication, low GDP countries had on average 0.94 higher DAS28, 2.84 and 1.85 higher scores on TJC and SJC, respectively, and 11.50 higher ESR compared to high GDP countries. At the same time, patients from low GDP societies had a 0.41 and 0.21 lower score on patient and physician global assessment, respectively and 0.96 lower score on fatigue compared to high GDP countries. HAQ was 0.14 higher in countries with low GDP (Table 1).
Table 1. Association between clinical disease activity measures and person reported outcomes with GDP
|
|
Clinical disease activity measures |
Person reported outcomes |
||||||
|
DAS28 |
TJC |
SJC |
ESR |
PatGA |
Fatigue |
PhyGA |
HAQ |
|
|
GDP (low vs. high) (Adjusted model, including medication) |
0.94* |
2.84* |
1.85* |
11.5* |
-0.41* |
-0.96* |
-0.21* |
0.14* |
|
|
||||||||
|
GDP (low vs. high) (Adjusted model, excluding medication) |
0.97* |
2.92* |
1.75* |
11.8* |
-0.44* |
-1.01* |
-0.25* |
0.11* |
*p<0.05
Conclusion
Patients from countries with lower socio-economic welfare score worse on clinical measures of disease activity (DAS28 and its components), however, tend to score better on person reported outcomes (patient global assessment and fatigue) for the same level of objective disease activity. Cultural factors that may play a role in reporting of subjective outcomes should be further explored.
Disclosure:
P. Putrik,
None;
S. Ramiro,
None;
A. Keszei,
None;
I. Hmamouchi,
None;
M. Dougados,
None;
M. Hifinger,
Hexal AG, Germany,
3;
L. Gossec,
None;
A. Boonen,
None.
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