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Abstract Number: 2254

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)

Polina Putrik1, Sofia Ramiro2, Jon Orueta3, Edurne Alonso Moran4, Roberto Nuno Solinis5 and Annelies Boonen6, 1Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands, 2Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 3Centro de Salud de Astrabudua, Osakidetza, Basque Health Service, Erandio, Spain, 4O+berri, Basque Institute for Healthcare Innovation, Barakaldo, Spain, 5Universidad Deusto, Bilbao, Spain, 6Maastricht University Medical Center, Maastricht, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Epidemiologic methods, musculoskeletal disorders, rheumatic disease and socio-economic inequities

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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).

Table.   Occurrence of diagnoses and costs by deprivation status across RMDs.

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.


Disclosure: P. Putrik, None; S. Ramiro, None; J. Orueta, None; E. Alonso Moran, None; R. Nuno Solinis, None; A. Boonen, None.

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.
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