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Zhu L, Moreland LW, Ascherman D. Cross-sectional association between social and demographic factors and disease activity in rheumatoid arthritis. BMC Rheumatol 2024; 8:2. [PMID: 38238799 PMCID: PMC10797737 DOI: 10.1186/s41927-023-00371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/23/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND This study aimed to assess the association between social factors, demographic parameters, and disease activity among rheumatoid arthritis (RA) patients. METHODS The University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry was used for this study and included patients meeting 1987 ACR criteria for RA enrolled between 2010-2015. The registry collected clinical and laboratory data at each visit, permitting the calculation of disease activity measures that included Disease Activity 28-C Reactive Protein (DAS28-CRP). The current study was conducted as a cross-sectional study in which baseline data were used to construct multiple logistic regression models assessing the relationship between disease activity measures (DAS28-CRP), functional capacity (health assessment questionnaire (HAQ)), selected demographic and social factors (occupation, education, income, marital status, race, gender, age, and BMI), and clinical/laboratory variables. RESULTS The analyses included 729 patients with baseline DAS28-CRP and social/demographic data. The mean age at enrollment was 59.5 (Standard Deviation (SD) = 12.7) years, 78% were female, and the median RA disease duration was 9.8 (Interquartile Range (IQR): 3.7, 19.1) years. We dichotomized the DAS28-CRP score and defined scores above or below 3.1 as high versus low RA disease activity. Most patients with high RA disease activity (N = 326, 45%) had less than a college degree (70%), were not working/retired/disabled (71%), and had an annual income under $50 K (55%). We found that higher body mass index (BMI) (Odds Ratio (OR) = 1.04, 95% CI: 1.01-1.08), longer disease duration (> 2 and < 10 years versus ≤ 2 years of disease) (OR = 0.45, 95% CI: 0.25-0.78), and being retired (OR = 1.74, 95% CI: 1.02-2.98) were associated with RA disease activity. CONCLUSION Increased RA activity may be associated with various social factors, potentially leading to more severe and debilitating disease outcomes. These findings provide evidence to support efforts to monitor disparities and achieve health equity in RA.
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Affiliation(s)
- Lei Zhu
- Division of Rheumatology and Clinical Immunology, School of Medicine, University of Pittsburgh, BST S723, 200 Lothrop Street, Pittsburgh, PA, 15261, USA
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Larry W Moreland
- Division of Rheumatology, School of Medicine, and Orthopedics, University of Colorado, Aurora, CO, USA
| | - Dana Ascherman
- Division of Rheumatology and Clinical Immunology, School of Medicine, University of Pittsburgh, BST S723, 200 Lothrop Street, Pittsburgh, PA, 15261, USA.
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2
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Lane CY, Lo D, Thoma LM, Zhang T, Varma H, Dalal DS, Baker TA, Shireman TI. Sociocultural and Economic Disparities in Physical Therapy Utilization Among Insured Older Adults With Rheumatoid Arthritis. J Rheumatol 2023; 50:1414-1421. [PMID: 37527853 DOI: 10.3899/jrheum.2023-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To examine influences of sociocultural and economic determinants on physical therapy (PT) utilization for older adults with rheumatoid arthritis (RA). METHODS In these annual cross-sectional analyses between 2012 and 2016, we accessed Medicare enrollment data and fee-for-service claims. The cohort included Medicare beneficiaries with RA based on 3 diagnosis codes or 2 codes plus a disease-modifying antirheumatic drug medication claim. We defined race and ethnicity and dual Medicare/Medicaid coverage (proxy for income) using enrollment data. Adults with a Current Procedural Terminology code for PT evaluation were classified as utilizing PT services. Associations between race and ethnicity and dual coverage and PT utilization were estimated with logistic regression analyses. Potential interactions between race and ethnicity status and dual coverage were tested using interaction terms. RESULTS Of 106,470 adults with RA (75.1% female; aged 75.8 [SD 7.3] years; 83.9% identified as non-Hispanic White, 8.8% as non-Hispanic Black, 7.2% as Hispanic), 9.6-12.5% used PT in a given year. Non-Hispanic Black (adjusted odds ratio [aOR] 0.77, 95% CI 0.73-0.82) and Hispanic (aOR 0.92, 95% CI 0.87-0.98) individuals had lower odds of PT utilization than non-Hispanic White individuals. Adults with dual coverage (lower income) had lower odds of utilization than adults with Medicare only (aOR 0.44, 95% CI 0.43-0.46). There were no significant interactions between race and ethnicity status and dual coverage on utilization. CONCLUSION We found sociocultural and economic disparities in PT utilization in older adults with RA. We must identify and address the underlying factors that influence these disparities in order to mitigate them.
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Affiliation(s)
- Chris Y Lane
- C.Y. Lane, PT, DPT, L.M. Thoma, PT, DPT, PhD, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
| | - Derrick Lo
- D. Lo, ScM, T. Zhang, MD, PhD, H. Varma, MS, D.S. Dalal, MD, MPH, T.I. Shireman, PhD, Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, Rhode Island
| | - Louise M Thoma
- C.Y. Lane, PT, DPT, L.M. Thoma, PT, DPT, PhD, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tingting Zhang
- D. Lo, ScM, T. Zhang, MD, PhD, H. Varma, MS, D.S. Dalal, MD, MPH, T.I. Shireman, PhD, Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, Rhode Island
| | - Hiren Varma
- D. Lo, ScM, T. Zhang, MD, PhD, H. Varma, MS, D.S. Dalal, MD, MPH, T.I. Shireman, PhD, Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, Rhode Island
| | - Deepan S Dalal
- D. Lo, ScM, T. Zhang, MD, PhD, H. Varma, MS, D.S. Dalal, MD, MPH, T.I. Shireman, PhD, Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, Rhode Island
| | - Tamara A Baker
- T.A. Baker, PhD, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Theresa I Shireman
- D. Lo, ScM, T. Zhang, MD, PhD, H. Varma, MS, D.S. Dalal, MD, MPH, T.I. Shireman, PhD, Department of Health Services, Policy and Practices, Brown University School of Public Health, Providence, Rhode Island
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3
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Astrike-Davis EM, Cleveland RJ, Louis Bridges S, Jonas BL, Callahan LF. Associations of Socioeconomic Status With Disease Progression in African Americans With Early Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:85-91. [PMID: 35468261 PMCID: PMC9592673 DOI: 10.1002/acr.24896] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/15/2022] [Accepted: 04/12/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In prior cross-sectional analyses of African American patients with rheumatoid arthritis (RA), measures of socioeconomic status (SES) were associated with clinical joint damage and poorer patient-reported outcome scores. The purpose of this study was to determine whether SES measures are associated with disease progression in a cohort of African American patients with early RA (<2 years duration). METHODS We analyzed baseline SES and change in 60-month clinical radiographs and patient-reported outcomes data (n = 101 and 177, respectively) in individuals with early RA. SES measures were educational attainment, occupation, homeownership, household income, and block group poverty. Outcomes were based on radiographs (total erosion and joint space narrowing [JSN] scores on hands and feet) and patient-reported outcomes (pain, fatigue, disability, and learned helplessness). We used logistic regression with mixed effects accounting for study site to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS Both low education and occupation status were associated with worsening pain (adjusted OR 5.86 [95% CI 3.05-11.3] and adjusted OR 2.55 [95% CI 1.54-4.21], respectively). Patients without a high-school diploma were more likely to have worsened reports of learned helplessness (OR 1.92 [95% CI 1.37-2.67]). Community measures of SES were also significantly associated with patient-reported outcomes score changes. Patients living in areas of block group poverty ≥20% were twice as likely to experience increased disability scores over 60 months of disease duration (OR 1.95 [95% CI 1.17-3.25]). We found no association between SES measures and erosion or JSN score progression. CONCLUSION Low educational attainment and nonprofessional occupation status were associated with increased worsening of patient-reported outcomes. However, there were no corresponding increases in radiographically assessed erosion or JSN score progression.
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Affiliation(s)
| | | | - S Louis Bridges
- Hospital for Special Surgery and Weill Cornell Medical College, New York, New York
| | - Beth L Jonas
- University of North Carolina at Chapel Hill School of Medicine
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4
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Thomsen T, Esbensen BA, Hetland ML, Aadahl M. Characteristics of participants and decliners from a randomized controlled trial on physical activity in patients with rheumatoid arthritis: a retrospective register-based cross-sectional study. Scand J Rheumatol 2023; 52:17-24. [PMID: 34726121 DOI: 10.1080/03009742.2021.1975394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE A randomized controlled trial [Joint Resources - Sedentary Behaviour (JR-SB) intervention] aimed to reduce sedentary behaviour and increase light-intensity physical activity in patients with rheumatoid arthritis (RA) through motivational counselling and text messages. Since a large proportion of invited patients declined to participate, this study aims to compare sociodemographic, clinical, and lifestyle factors between included patients and patients declining to participate (non-participants) in the JR-SB study and to investigate which characteristics were associated with participation. METHOD A register-based cross-sectional study was conducted. All patients invited to participate in the JR-SB study were identified in the DANBIO registry, from which patients' clinical and lifestyle data were also retrieved. Data on sociodemography and comorbidity were extracted from national registers. Differences between participants and non-participants were determined by an independent t-test or a chi-squared test. Logistic regression analyses adjusted for various confounders tested the association of patient characteristics with the likelihood of participation in the JR-SB study. RESULTS A total of 467 (58%) declined participation in the JR-SB study. Non-participants were older and less educated, more were smokers, fewer performed regular physical activity, and more had comorbidity compared to participants. Regression analyses showed that a higher educational level and absence of comorbidity in particular were associated with participation in the JR-SB study. CONCLUSION Patients with RA who are less educated and with certain types of comorbidity are less motivated to participate in a physical activity intervention. The findings may inform the recruitment process and implementation of physical activity interventions in rheumatology clinical practice.
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Affiliation(s)
- T Thomsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - B A Esbensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - M Aadahl
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Dey M, Busby A, Elwell H, Lempp H, Pratt A, Young A, Isaacs J, Nikiphorou E. Association between social deprivation and disease activity in rheumatoid arthritis: a systematic literature review. RMD Open 2022; 8:rmdopen-2021-002058. [PMID: 35450954 PMCID: PMC9024227 DOI: 10.1136/rmdopen-2021-002058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Physical and mental illnesses are driven by ethnicity, social, environmental and economic determinants. Novel theoretical frameworks in rheumatoid arthritis (RA) focus on links and adverse interactions between and within biological and social factors. This review aimed to summarise associations between socioeconomic status (SES) and RA disease activity, and implications for future research. Articles studying the association between SES and RA disease activity were identified, from 1946 until March 2021. The research question was: Is there an association between social deprivation and disease activity in people with RA? Articles meeting inclusion criteria were examined by one author, with 10% screened at abstract and full paper stage by a second author. Disagreements were resolved with input from a third reviewer. Information was extracted on definition/measure of SES, ethnicity, education, employment, comorbidities, disease activity and presence/absence of association between SES and disease activity. Initially, 1750 articles were identified, with 30 articles ultimately included. SES definition varied markedly—10 articles used a formal scale and most used educational attainment as a proxy. Most studies controlled for lifestyle factors including smoking and body mass index, and comorbidities. Twenty-five articles concluded an association between SES and RA disease activity; two were unclear; three found no association. We have demonstrated the association between low SES and worse RA outcomes. There is a need for further research into the mechanisms underpinning this, including application of mixed-methods methodology and consideration of syndemic frameworks to understand bio–bio and bio–social interactions, to examine disease drivers and outcomes holistically.
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Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, Brownlow Hill, University of Liverpool, Liverpool, UK .,Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Amanda Busby
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London, UK
| | - Heidi Lempp
- Academic Department of Rheumatology, Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Arthur Pratt
- Translational and Clinical Research Institute, Framlington Place, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - John Isaacs
- Translational and Clinical Research Institute, Framlington Place, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Elena Nikiphorou
- Academic Department of Rheumatology, Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UK.,Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
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6
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Thoma LM, Cleveland RJ, Jonas BL, Bridges SL, Callahan LF. Association of Disease Activity and Disability With Rehabilitation Utilization in African American Adults With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2022; 74:16-21. [PMID: 34586720 PMCID: PMC8720062 DOI: 10.1002/acr.24797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/28/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association of disease activity and disability with rehabilitation utilization in African American adults with rheumatoid arthritis (RA). METHODS We analyzed cross-sectional baseline data from the Consortium for the Longitudinal Evaluation of African Americans with RA (CLEAR) I and CLEAR II registry. Disease activity was quantified with the Disease Activity Score in 28 joints using the C-reactive protein level. Disability was measured with the Health Assessment Questionnaire. Rehabilitation utilization was determined by self-reported recall of physical therapy or occupational therapy visits in the prior 6 months or ever. We examined the association of disease activity and disability with rehabilitation utilization using separate binary logistic regression models to estimate odds ratios and 95% confidence intervals and adjusted for potential confounders. We repeated the analyses with the sample stratified by disease duration (early RA and established RA). RESULTS Of 1,067 participants, 14% reported utilizing rehabilitation in the prior 6 months, and 41% reported ever utilizing rehabilitation. Rehabilitation utilization in the prior 6 months was similar among those with early and established RA (12% versus 16%). A greater proportion of those with established RA reported any past rehabilitation utilization (28% versus 50%). Among those with established RA but not early RA, worse disability was associated with rehabilitation utilization in the prior 6 months. Disease activity was not associated with either outcome. CONCLUSION Among African American adults with RA, rehabilitation utilization in the 6 months prior to assessment was low and associated with disability but not disease activity. Factors driving rehabilitation utilization are unclear.
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Affiliation(s)
| | | | | | - S. Louis Bridges
- Hospital for Special Surgery and Weill Cornell College of Medicine
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7
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Delay and diagnostic pathway of patients with psoriatic arthritis in Spain. ACTA ACUST UNITED AC 2021; 17:525-529. [PMID: 34756314 DOI: 10.1016/j.reumae.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Delayed diagnosis results in a worse prognosis in patients with psoriatic arthritis. Our objective is to determine the diagnostic delay, the specialties consulted and the referral points of patients with psoriatic arthritis in our environment. PATIENTS AND METHODS We distributed a survey to members of the Spanish association Acción Psoriasis inquiring about the objectives of the study. RESULTS A total of 503 surveys were analysed. The diagnostic delay was 4.01 ± 1.42 years. The proportion of patients who had consulted, before diagnosis, primary care was 79.9%, traumatology 33.8% and the emergency department was 30.2%. The proportion of referrals that eventually led to diagnosis came from primary care in 29.3% of cases, traumatology 15.8% and the emergency department 3.5%. DISCUSSION AND CONCLUSIONS The delay in diagnosis far outweighs other European results. Emergency departments are an important transit point for these patients, but the proportion of referrals is very low. We believe that focusing on the importance of early diagnosis in this particular medical sector could resolve a large part of diagnostic delay.
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8
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Kumaradev S, Roux C, Sellam J, Perrot S, Pham T, Dugravot A, Molto A. Sociodemographic determinants in the evolution of pain in inflammatory rheumatic diseases: results from ESPOIR and DESIR cohorts. Rheumatology (Oxford) 2021; 61:1496-1509. [PMID: 34270700 PMCID: PMC8996788 DOI: 10.1093/rheumatology/keab562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/30/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether socio-demographic factors are associated with heterogeneity in pain evolution in inflammatory rheumatic diseases (IRDs) after accounting for disease-specific characteristics in a system with universal health care. Methods This analysis included the data from two prospective observational cohorts of early IRDs (ESPOIR for early RA and DESIR for early SpA). Data on pain was measured, respectively, on 13 and 9 occasions spanning 10 and 6 years of follow-up using the Short-Form 36 bodily pain score for 810 participants of ESPOIR, and 679 participants of DESIR. Linear mixed models were used to characterize differences in pain evolution as a function of age (tertiles), sex, ethnicity, education, marital, and professional status, after accounting for disease-related, treatment, lifestyle, and health factors. Results While transitioning from early (disease duration ≤6 months for RA and ≤3 years for SpA) to long-standing disease, differences in pain evolution emerged as a function of age (P < 0.001), sex (P = 0.050), and ethnicity (P = 0.001) in RA, and as a function of age (P = 0.048) in SpA; younger age, males, and Caucasians exhibited lower pain in the latter phases of both diseases. Highly educated participants (RA, β = −3.8, P = 0.007; SpA, β = −6.0, P < 0.001) for both diseases, and Caucasians (β = −5.6, P = 0.021) for SpA presented with low pain early in the disease, with no changes throughout disease course. Conclusion Being older, female, non-Caucasian and having lower education was found to be associated with worse pain in early and/or long-standing IRDs, despite universally accessible health-care. Early identification of at-risk populations and implementation of multidisciplinary strategies may reduce patient-reported health outcome disparities. Trial registration registrations ESPOIR: ClinicalTrials.gov, www.clinicaltrials.gov, NCT03666091. DESIR: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01648907.
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Affiliation(s)
- Sushmithadev Kumaradev
- Clinical epidemiology applied to rheumatic and musculoskeletal diseases, Inserm 1153, Université de Paris, Paris, France.,Epidemiology of Ageing and Neurodegenerative diseases, Inserm 1153, Université de Paris, Paris, France
| | - Christian Roux
- Clinical epidemiology applied to rheumatic and musculoskeletal diseases, Inserm 1153, Université de Paris, Paris, France.,Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, APHP-Centre, Saint-Antoine Hospital, Paris, France
| | - Serge Perrot
- Pain clinic, APHP-Centre, INSERM U897, Cochin Hospital, Paris, France
| | - Thao Pham
- Department of Rheumatology, APHM, Sainte-Marguerite Hospital, Aix-Marseille Univ, Marseille, France
| | - Aline Dugravot
- Epidemiology of Ageing and Neurodegenerative diseases, Inserm 1153, Université de Paris, Paris, France
| | - Anna Molto
- Clinical epidemiology applied to rheumatic and musculoskeletal diseases, Inserm 1153, Université de Paris, Paris, France.,Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France
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9
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Castillo-Cañón JC, Trujillo-Cáceres SJ, Bautista-Molano W, Valbuena-García AM, Fernández-Ávila DG, Acuña-Merchán L. Rheumatoid arthritis in Colombia: a clinical profile and prevalence from a national registry. Clin Rheumatol 2021; 40:3565-3573. [PMID: 33772350 DOI: 10.1007/s10067-021-05710-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/24/2021] [Accepted: 03/21/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a need to describe the demographic and clinical characteristics of people diagnosed with rheumatoid arthritis who are attended within the Colombian health system. This characterization allows prioritizing populations with specific risks, programming the use of health services, and planning the costs necessary to guarantee equitable care. OBJECTIVE To assess the demographic and clinical characteristics of a cohort of patients with rheumatoid arthritis using national data collected by the High-Cost Disease Fund (CAC in Spanish). METHODS A cross-sectional study from a secondary source. Data was gathered from a national administrative registry. A descriptive analysis was performed on sociodemographic and clinical characteristics. Age-standardized prevalence was estimated at national level and by geographical regions. Remission rates were also estimated for Colombian departments and regions. RESULTS By 2019, 81,386 patients with rheumatoid arthritis were reported in Colombia. The relation female-male was 5.2:1. The median age was 59 years (IQR: 50-67). Prevalence was higher in people aged 50-69 years. The most frequent comorbidities were high blood pressure (31.15%) and osteoporosis (19.46%). Age-standardized prevalence of rheumatoid arthritis was 0.24 per 100 population (95% CI: 0.23-0.24). In cases with complete information, 57.57% of departments had remission rates up to 30%. CONCLUSION Rheumatoid arthritis in Colombia was more frequent in females aged ≥50 year. Age-standardized prevalence was lower than reported by other studies performed in Colombia but similar to the estimated internationally for the country. Key Points • More than 80,000 rheumatoid arthritis patients were reported to this national registry in Colombia in 2019, finding an age-standardized prevalence of 0.24 per 100 population. • Hypertension was the most common comorbidity reported in people with rheumatoid arthritis. This finding is similar to the reports by similar studies such as the COMORA. • A major strength of this study is the large sample size since data come from a nationwide registry of people with rheumatoid arthritis, supported by the National Ministry of Health. Additionally, this registry has a rigorous data monitoring process that guarantees the internal validity of data and provides valuable information for decision-making based on local evidence. • Prevalence of rheumatoid arthritis was higher in females between 50 and 65 years. Age-standardized prevalence was lower than previously reported in Colombia, but similar to the world estimations.
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Affiliation(s)
| | | | - Wilson Bautista-Molano
- University Hospital Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá D.C., Colombia
| | | | - Daniel G Fernández-Ávila
- Rheumatology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio-School of Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
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10
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Guillen Astete CA, Gaite Gonzalez I, Zurita Prada PA, Urrego Laurin C. Delay and Diagnostic Pathway of Patients with Psoriatic Arthritis in Spain. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30137-6. [PMID: 32646842 DOI: 10.1016/j.reuma.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Delayed diagnosis results in a worse prognosis in patients with psoriatic arthritis. Our objective is to determine the diagnostic delay, the specialties consulted and the referral points of patients with psoriatic arthritis in our environment. PATIENTS AND METHODS We distributed a survey to members of the Spanish association Acción Psoriasis inquiring about the objectives of the study. RESULTS A total of 503 surveys were analysed. The diagnostic delay was 4.01±1.42 years. The proportion of patients who had consulted, before diagnosis, primary care was 79.9%, traumatology 33.8% and the emergency department was 30.2%. The proportion of referrals that eventually led to diagnosis came from primary care in 29.3% of cases, traumatology 15.8% and the emergency department 3.5%. DISCUSSION AND CONCLUSIONS The delay in diagnosis far outweighs other European results. Emergency departments are an important transit point for these patients, but the proportion of referrals is very low. We believe that focusing on the importance of early diagnosis in this particular medical sector could resolve a large part of diagnostic delay.
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Affiliation(s)
- Carlos Antonio Guillen Astete
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España; Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Unidad de Reumatología, Hospital Universitario HLA Moncloa, Madrid, España.
| | | | - Pablo Antonio Zurita Prada
- Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Unidad de Reumatología, Hospital Universitario HLA Moncloa, Madrid, España
| | - Claudia Urrego Laurin
- Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Unidad de Reumatología, Hospital Universitario HLA Moncloa, Madrid, España
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11
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Hirsch J, Mehta B, Finik J, Navarro-Millan I, Brantner C, Mirza S, Figgie M, Parks M, Russell L, Orange D, Goodman S. Racial disparities in pre-operative pain, function and disease activity for patients with rheumatoid arthritis undergoing Total knee or Total hip Arthroplasty: a New York based study. BMC Rheumatol 2020; 4:17. [PMID: 32161847 PMCID: PMC7049203 DOI: 10.1186/s41927-020-0117-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background Black and Hispanic patients with osteoarthritis have more pain and worse function than Whites at the time of arthroplasty. Whether this is true for patients with rheumatoid arthritis (RA) is unknown. Methods This cross-sectional study used data on RA patients acquired between October 2013 and November 2018 prior to elective total knee (TKA) or hip arthroplasty (THA). Pain, function, and disease activity were assessed using the visual analogue scale (VAS), the Multidimensional Health Assessment Questionnaire (MDHAQ), and the Disease Activity Score (DAS28-ESR). We linked the cases to census tracts using geocoding to determine the community poverty level. Race, education, income, insurance and medications were collected via self-report. Using multivariable linear and logistic models we examined whether minority status predicted pain, function and RA disease activity at the time of arthroplasty. Results Thirty seven (23%) of the 164 patients were Black or Hispanic (minorities). The MDHAQ and DAS28-ESR were not significantly worse while VAS pain score was significantly worse in minority patients (p = 0.03). There was no significant difference in education between the groups. Insurance varied significantly; 29% of minority patients had Medicaid vs. 0% of Whites (p < 0.0001). In the multivariable analyses minority status was not significantly associated with DAS28-ESR [p = 0.66], MDHAQ [p = 0.26], or VAS pain [p = 0.18]. Conclusions For Black and/or Hispanic patients with RA undergoing THA or TKA at a high-volume specialty hospital, unlike Black or Hispanic patients with osteoarthritis (OA), there was no association with worse pain, function, or RA disease activity at the time of elective arthroplasty.
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Affiliation(s)
- J Hirsch
- 1Mount Sinai St. Luke's-West, New York, NY USA
| | - B Mehta
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
| | - J Finik
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - I Navarro-Millan
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
| | - C Brantner
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - S Mirza
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - M Figgie
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - M Parks
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA
| | - L Russell
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
| | - D Orange
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,4The Rockefeller University, New York, NY USA
| | - S Goodman
- 2Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021 USA.,3Weill Cornell Medicine, New York, NY USA
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Ghawi H, Crowson CS, Rand-Weaver J, Krusemark E, Gabriel SE, Juhn YJ. A novel measure of socioeconomic status using individual housing data to assess the association of SES with rheumatoid arthritis and its mortality: a population-based case-control study. BMJ Open 2015; 5:e006469. [PMID: 25926142 PMCID: PMC4420936 DOI: 10.1136/bmjopen-2014-006469] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess whether HOUSES (HOUsing-based index of socioeconomic status (SES)) is associated with risk of and mortality after rheumatoid arthritis (RA). DESIGN We conducted a population-based case-control study which enrolled population-based RA cases and their controls without RA. SETTING The study was performed in Olmsted County, Minnesota. PARTICIPANTS Study participants were all residents of Olmsted County, Minnesota, with RA identified using the 1987 American College of Rheumatology criteria for RA from 1 January 1988, to 31 December 2007, using the auspices of the Rochester Epidemiology Project. For each patient with RA, one control was randomly selected from Olmsted County residents of similar age and gender without RA. PRIMARY AND SECONDARY OUTCOME MEASURE The disease status was RA cases and their matched controls in relation to HOUSES as an exposure. As a secondary aim, post-RA mortality among only RA cases was an outcome event. The associations of SES measured by HOUSES with the study outcomes were assessed using logistic regression and Cox models. HOUSES, as a composite index, was formulated based on a summed z-score for housing value, square footage and number of bedrooms and bathrooms. RESULTS Of the eligible 604 participants, 418 (69%) were female; the mean age was 56±15.6 years. Lower SES, as measured by HOUSES, was associated with the risk of developing RA (0.5±3.8 for controls vs -0.2±3.1 for RA cases, p=0.003), adjusting for age, gender, calendar year of RA index date, smoking status and BMI. The lowest quartile of HOUSES was significantly associated with increased post-RA mortality compared to higher quartiles of HOUSES (HR 1.74; 95% CI 1.10 to 2.74; p=0.017) in multivariate analysis. CONCLUSIONS Lower SES, as measured by HOUSES, is associated with increased risk of RA and mortality after RA. HOUSES may be a useful tool for health disparities research concerning rheumatological outcomes when conventional SES measures are unavailable.
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Affiliation(s)
- Husam Ghawi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Health Sciences Research and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer Rand-Weaver
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Krusemark
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Health Sciences Research and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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