medwireNews: Socioeconomic deprivation is associated with worse functional status (FS) and a greater decline in functioning over time among people with rheumatoid arthritis (RA), suggest findings from a US study published in JAMA Network Open.
Zara Izadi (University of California, San Francisco, USA) and co-researchers analyzed data from 83,965 individuals with RA (77% women) who were included in the American College of Rheumatology’s RISE database in 2016–2018. The most commonly reported measure of FS was Multidimensional Health Assessment Questionnaire (MDHAQ; 68%), followed by HAQ (24%) and HAQ II (8%).
Overall, increasing scores on the Area Deprivation Index (ADI) were associated with higher FS scores, indicating worse disability, irrespective of the measure used. For example, the average MDHAQ score was 1.79 points for people in the lowest ADI quintile compared with 2.43 points for those in the highest ADI quintile.
Moreover, longitudinal analysis over at least 1 year of follow-up demonstrated that worsening deprivation was associated with increasing probability of functional decline, defined as an increase of at least 1.20 points for MDHAQ, 0.25 points for HAQ, and 0.28 points for HAQ II.
The computed probability of functional decline after adjustment for factors including age, race/ethnicity, number of visits to a rheumatology practice, and baseline score was 14.1% for people in the lowest ADI quintile, rising to 15.5%, 16.6%, and 16.8% in the second, third, and fourth quintiles, respectively, and was greatest, at 18.9%, in the highest quintile.
Izadi and team note that “[r]esearch on social determinants is limited in RA,” and the reasons for the observed associations are not fully understood.
“Access to care is often thought to be a major driver of disparities,” but because the associations were seen after controlling for the number of visits to a rheumatology practice, the findings suggest “that utilization of rheumatology care is not sufficient to eliminate disparate health outcomes,” they add.
The researchers say that “a small but statistically significant proportion” of the relationship between socioeconomic deprivation and functional decline was mediated by RA disease activity, and therefore “improving disparities in FS will require understanding the reasons for higher disease activity among patients in the lowest [socioeconomic status] groups.”
They conclude that the study results “provide a framework for monitoring disparities in RA and for generating evidence to spur action toward achieving health equity.”
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