Session Information
Date: Tuesday, November 10, 2015
Session Title: Epidemiology and Public Health Poster III (ACR): Gout and Non-Inflammatory Musculoskeletal Conditions
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Rheumatic and musculoskeletal diseases (RMDs) are prevalent and have a strong impact on health care costs. Some evidence in specific diseases indicates that patients with lower socio-economic background are at higher risk to have the disease and incur more healthcare costs. However, knowledge whether these effects of socio-economic status are comparable across all RMDs is lacking. Objective of this study was to compare the impact of socio-economic deprivation on occurrence of different RMDs and associated health care costs.
Methods:
An administrative dataset linking clinical (based on ICD codes), sociodemographics (age, gender and deprivation index) and health care utilization costs information of the entire adult (>=18 y.o.) population of the Basque Country, Spain was used. Deprivation index was based on area employment and education status, and included five categories (1 to 5 (most deprived)). Costs included primary and specialist care, planned and emergency hospital admissions, and ambulatory drug prescriptions. Thirty-six individual diseases were grouped into seven larger diagnostic groups: Rheumatoid Arthritis, Crystal Arthropathies, Osteoarthritis, Soft tissue diseases, Connective Tissue Diseases, and Vasculitis (Table). Logistic and Poisson regression models were computed to explore the relation between the deprivation index and occurrence of the disease (separately and grouped) and health care utilization costs, respectively. All models were adjusted for age and gender.
Results:
In total, data from 1,923,156 individuals were analyzed. Mean age was 49.9 (SD18:4), 49% were males. Soft tissue diseases were the most prevalent (5.5%), third most costly in terms of health care utilization costs after vasculitis and rheumatoid arthritis. Socio-economic deprivation was associated with higher likelihood to have any RMDs except vasculitis and some connective tissue diseases. The strongest socio-economic gradient was seen for occurrence of soft tissue disease (OR 1.82 [95%CI 1.78;1.85], most vs. least deprived). Deprivation was also associated with higher costs across the majority of the conditions, but a somewhat different pattern across diseases was seen, as the strongest gradients were observed in patients with Spondyloarthritis (in particular. with Ankylosing spondylitis) and Vasculitis (Table).
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Table. Occurrence of diagnoses and costs by deprivation status across RMDs. |
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|
Disease |
N(%) |
Mean (SD) total healthcare cost per patient per year (€) |
OR to have disease (most deprived vs least deprived) |
IRR total costs (most deprived vs least deprived) |
|
Rheumatoid arthritis |
4042 (0.21%) |
3865.93 (6296.16) |
1.32 [1.19;1.46] |
1.33 [1.33;1.33] |
|
Rheumatoid arthritis |
3533 (0.18%) |
4011.07 (6426.18) |
1.30 [1.17;1.45] |
1.38 [1.38;1.38] |
|
Undifferentiated (poly)arthritis |
536 (0.03%) |
2915.41 (5112.51) |
1.51 [1.13;2.01] |
0.97 [0.96;0.97] |
|
Spondyloarthritis |
1808 (0.09%) |
2785.1 (6830.4) |
1.43 [1.22;1.68] |
1.66 [1.65;1.67] |
|
Ankylosing spondylitis |
660 (0.03%) |
2369.33 (6078.65) |
1.72 [1.31;2.25] |
2.10 [2.08;2.11] |
|
Psoriatic arthritis |
992 (0.05%) |
2683.28 (6265.25) |
1.35 [1.08;1.68] |
1.59 [1.58;1.60] |
|
Reactive arthritis |
66 (0.00%) |
5563.67 (12785.33) |
0.38 [0.14;1.06] |
0.77 [0.75;0.78] |
|
Undifferentiated spondyloarthritis |
110 (0.01%) |
4390.99 (9363.84) |
1.66 [0.91;3.04] |
1.69 [1.67;1.70] |
|
Crystal Arthropathies |
3899 (0.2%) |
3162.69 (5987.09) |
1.65 [1.47;1.84] |
1.13 [1.13;1.13] |
|
Gout |
3545 (0.18%) |
3151.88 (6057.05) |
1.63 [1.46;1.83] |
1.09 [1.09;1.09] |
|
Other crystal arthropathy |
362 (0.02%) |
3270.80 (5214.10) |
1.74 [1.22;2.48] |
1.44 [1.43;1.44] |
|
Osteoarthritis |
41924 (2.18%) |
3117.88 (4825.14) |
1.59 [1.54;1.64] |
1.22 [1.22;1.22] |
|
Knee Osteoarthritis |
10559 (0.55%) |
3545.09 (5205.92) |
1.90 [1.78;2.03] |
1.18 [1.18;1.18] |
|
Hip Osteoarthritis |
5097 (0.27%) |
3711.49 (5493.39) |
1.33 [1.21;1.46] |
1.01 [1.01;1.01] |
|
Hand Osteoarthritis |
3599 (0.19%) |
2224.09 (3397.20) |
1.12 [1.01;1.25] |
1.33 [1.32;1.33] |
|
Osteoarthritis other |
5304 (0.28%) |
2960.97 (4612.84) |
1.59 [1.45;1.74] |
1.31 [1.30;1.31] |
|
Degenerative neck disease (cervical spine) |
3300 (0.17%) |
2711.11 (4466.96) |
1.53 [1.36;1.72] |
1.33 [1.32;1.33] |
|
Chronic low back pain (excluding degenerative) |
12972 (0.67%) |
3043.48 (4756.90) |
1.62 [1.53;1.72] |
1.26 [1.26;1.26] |
|
Osteoarthritis generalized |
7054 (0.37%) |
3504.27 (5082.43) |
1.61 [1.49;1.75] |
1.26 [1.25;1.26] |
|
Soft tissue diseases |
105656 (5.49%) |
2271.56 (4027.57) |
1.82 [1.78;1.85] |
1.23 [1.23;1.23] |
|
Chronic low back pain (excluding degenerative) |
66867 (3.48%) |
2341.16 (4162.52) |
1.86 [1.81;1.91] |
1.23 [1.23;1.23] |
|
Chronic neck pain (excluding degenerative) |
17357 (0.9%) |
2093.08 (3568.17) |
1.99 [1.89;2.09] |
1.16 [1.16;1.16] |
|
Fibromyalgia |
3056 (0.16%) |
2800.76 (4477.42) |
1.70 [1.51;1.91] |
1.40 [1.40;1.41] |
|
Soft tissue disease |
38548 (2%) |
2270.59 (3791.02) |
1.67 [1.61;1.72] |
1.27 [1.27;1.27] |
|
Connective Tissue Diseases |
738 (0.04%) |
3495.55 (5206.72) |
1.33 [1.04;1.69] |
1.29 [1.29;1.30] |
|
Systemic lupus erythematosus |
590 (0.03%) |
3179.44 (4908.92) |
1.31 [1.00;1.72] |
1.27 [1.27;1.28] |
|
Sjogren’s disease |
63 (0%) |
5224.62 (7098.54) |
0.89 [0.37;2.12] |
0.91 [0.90;0.92] |
|
Systemic sclerosis |
44 (0%) |
4989.50 (5586.01) |
1.98 [0.71;5.44] |
3.54 [3.47;3.60] |
|
Myositis |
76 (0%) |
3134.68 (3076.92) |
0.99 [0.44;2.21] |
0.99 [0.97;1.01] |
|
Other connective tissue disease |
51 (0%) |
4149.71 (4991.57) |
1.77 [0.63;4.98] |
0.96 [0.95;0.98] |
|
Vasculitis |
300 (0.02%) |
5235.52 (7924.52) |
1.10 [0.74;1.63] |
1.98 [1.96;1.99] |
|
ANCA associated vasculitis |
38 (0%) |
5865.84 (6629.81) |
1.55 [0.34;6.96] |
3.86 [3.70;4.02] |
|
Non-ANCA associated vasculitis |
264 (0.01%) |
5219.53 (8163.03) |
1.08 [0.72;1.62] |
1.95 [1.94;1.96] |
|
Osteoporosis |
15049 (0.78%) |
2945.37 (4630.94) |
1.09 [1.03;1.14] |
1.34 [1.34;1.34] |
|
Polimyalgia rheumatica |
1935 (0.1%) |
3828.45 (5508.66) |
1.21 [1.04;1.41] |
1.16 [1.16;1.16] |
|
Undifferentiated monoarthritis |
434 (0.02%) |
2614.93 (3578.13) |
1.48 [1.07;2.04] |
1.18 [1.17;1.19] |
Conclusion:
Socio-economic deprivation was consistently associated with higher occurrence and higher costs across most of the RMDs. Among major RMDs, the group of soft tissue diseases (comprising chronic low back and neck pain, fibromyalgia, and soft tissue disease), was the most prevalent and costly for the society, and occured more often in persons with lower socio-economic status.
To cite this abstract in AMA style:
Putrik P, Ramiro S, Orueta J, Alonso Moran E, Nuno Solinis R, Boonen A. Socio-Economically Deprived Patients Have a Higher Likelihood for Having Any Type of Rheumatic and Musculoskeletal Diseases and Have Higher Healthcare Costs – Results from a Population-Based Administrative Database Including 1.9 Million Persons (Basque country, Spain) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/socio-economically-deprived-patients-have-a-higher-likelihood-for-having-any-type-of-rheumatic-and-musculoskeletal-diseases-and-have-higher-healthcare-costs-results-from-a-population-based-administr/. Accessed April 14, 2021.« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/socio-economically-deprived-patients-have-a-higher-likelihood-for-having-any-type-of-rheumatic-and-musculoskeletal-diseases-and-have-higher-healthcare-costs-results-from-a-population-based-administr/