medwireNews: Individuals with rheumatic conditions living in areas with the highest social and heat vulnerability are significantly more likely to experience recurrent hospitalizations than those living in the least vulnerable areas, research suggests.
“A clearer understanding of the impact of environmental factors, especially as they disproportionately affect historically marginalized populations and communities, may allow for adaptive strategies to reduce racial, ethnic, and socioeconomic disparities in rheumatic disease care, utilization patterns and outcomes,” write Candace Feldman (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and co-authors in Arthritis Care & Research.
Feldman and team reviewed data for 14,401 individuals with rheumatic conditions from the Massachusetts General Brigham Research Patient Data Registry. Of these, 46.1% had inflammatory arthritis, 41.9% had osteoarthritis, 33.4% had systemic lupus erythematosus (SLE) or a connective tissue disease, 18.2% had crystalline arthritis, and 7.3% had vasculitis, with categories not mutually exclusive.
During a 2-year follow-up period, there were 8251 hospitalizations; 80.9% of individuals were not hospitalized, 14.3% had between one and three hospitalizations, and 4.8% had four or more.
After adjusting for age, sex, race/ethnicity, insurance, and comorbidities, the researchers found that individuals living in areas with the highest social vulnerability index (SVI; top quartile) were significantly more likely to be hospitalized between one and three times (odds ratio [OR=1.22]) or four or more times (OR=1.84) than those with the lowest SVI.
The team notes that the SVI characterizes “how susceptible a neighborhood is to hazardous events, and how readily a community can mobilize to prevent adverse effects,” and comprises four subindices: socioeconomic status; household composition and disability; race/ethnicity/language; and housing type and transportation.
Among the individual disease groups, the ORs for four or more hospitalizations associated with the highest SVI were a significant 2.06, 1.94, and 1.84 among people with osteoarthritis, crystalline arthritis, and inflammatory arthritis, respectively, with a similar but nonsignificant trend among those with SLE or connective tissue disease.
The authors also observed that individuals living in the areas with the highest heat vulnerability index (HVI) – which takes into account proximity to hazards (heat), and socioeconomic, occupational, health, and housing conditions that would predispose a population to adverse effects from climate changes – were significantly more likely to be hospitalized than those in areas with the lowest HVI. Specifically, the adjusted ORs were 1.35 for one to three hospitalizations and 1.64 for four or more hospitalizations.
In this analysis, ORs for four or more hospitalizations in the highest versus lowest HVI categories were a significant 1.81 and 1.78 among people with osteoarthritis and SLE or connective tissue disease, respectively, with a similar nonsignificant trend among those with crystalline or inflammatory arthritis.
Feldman et al conclude: “The effects of our climate emergency will soon be more frequent and severe; it is imperative that we understand which populations of our patients with rheumatic disease are at greatest risk for avoidable adverse events, and the mechanisms that contribute to this heightened risk.”
They continue: “Once identified, we can more effectively focus on mitigative and adaptive strategies to implement preventive measures, improve access to sustained high quality healthcare, and advocate for socioeconomic and political change.”
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