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Women, Less Educated Face Worse SpA Disease Activity, Physical Function
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There exist individual- and country-level health inequalities among patients with spondyloarthritis, with women and less educated people experiencing worse disease activity and physical function, according to data published in the Annals of the Rheumatic Diseases.
“Despite reasonable documentation of socioeconomic inequalities and inequities in [rheumatoid arthritis], it is not known whether differences in health outcomes across individual-level or country-level socioeconomic factors also exist in patients with spondyloarthritis (SpA),” Polina Putrik, PhD, of Maastricht University, and colleagues wrote.
The researchers noted, “Furthermore, although in European countries, eligibility criteria for initiating treatment with [biologic disease-modifying antirheumatic drugs] in SpA are more homogeneous across countries compared with RA, uptake of [biologic] DMARDs in SpA in specialized centers across the globe has been demonstrated to vary importantly.”
To analyze the effects of individual- and country-level socioeconomic factors have on disease activity and physical function in SpA, Putrik and colleagues reviewed data from the COMOSPA study, a cross-sectional, multicenter, observational trial of patients across 22 countries. The study enrolled consecutive adult patients with a diagnosis SpA visiting participating rheumatology centers in North America, South America, Europe, Asia and Africa. Putrik and colleague included 3,370 patients in their final analysis.
The researchers evaluated individual socioeconomic status and country information, as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Functional Index (BASFI) for each patient, using multilevel regression models and adjusting for clinical and demographic confounders. Putrik and colleagues also analyzed the effects of gross domestic product (GDP), Human Development Index (HDI), health care expenditure and the Gini index. They similarly evaluated the indirect effects of biologic DMARDs between education or GDP and ASDAS.
According to the researchers, the patients had a mean ASDAS of 2, and a mean BASFI score of 3.1. Women (OR = 1.7; 95% CI, 1.3-2.2) and those with less education (OR = 1.7; 95% CI, 1.4-2) demonstrated an increased likelihood of having an ASDAS of 2.1 or greater, according to the adjusted models. Women and patients with lower education also reported slightly worse physical function.
In addition, the researchers noted large country differences independent of individual socioeconomic factors and clinical cofounders. Patients from countries with less developed socioeconomic environments demonstrated worse ASDAS, although BASFI trends were insignificant. The uptake of biologicals failed to mediate the link between individual- and country-level socioeconomic factors and disease activity.
“Large country-level differences in disease outcomes among patients with SpA were seen, and they could be only partly explained by GDP, HDI or region of residence,” Putrik and colleagues wrote. “Individual-level socioeconomic inequalities were also pronounced, disfavoring women and low educated persons. At the same time, while patients in less developed countries had higher objectively measured disease activity, they overall reported to have a similar physical function (after adjusting for disease activity).”
They added, “Our findings point at socioeconomic inequalities in disease activity in patients with SpA and call for a consolidated action of all stakeholders to take those into account.” – by Jason Laday
Disclosure: Putrik reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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