Abstract:Objective
To examine cross-sectional baseline data from the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis Registry (CLEAR) for the association between socioeconomic status (SES) with clinical and self-report health outcomes.
Methods
We analyzed data on 937 African Americans (AA) who provided comprehensive sociodemographic data in addition to self-reported health outcomes. SES measures included educational attainment, homeownership, household income and occupa… Show more
“…In this study, education-based pain differences were present even in the early disease phase and persisted throughout. This is in accordance with antecedent studies that demonstrated higher pain in those with low education in both early [ 41 ] and long-standing disease [ 11 , 21 , 22 , 42 ]. Some showed a gradient in the association between years of education and pain [ 11 ].…”
Section: Discussionsupporting
confidence: 91%
“…In addition to disease severity [ 8 , 9 ], the treatment initiated [ 10 ] and individuals’ lifestyle and psychological health, it has been found that socio-demographic characteristics potentially contribute about 5–11% of the observed pain heterogeneity in IRDs [ 11 , 12 ]; older age [ 13 , 14 ], female sex [ 15–18 ], non-Caucasian ethnicity [ 19 ] and low socio-economic status [ 20 ] are associated with increased pain in IRDs; however, the consistency of this association throughout the disease course is unknown. Previous studies reporting associations between socio-demographic characteristics and pain in IRDs were based on cross-sectional [ 21 , 22 ] or longitudinal design that either did not account for non-linear evolution of pain in IRDs [ 11 ], were not based on repeatedly assessed pain measures [ 23 ], or were limited to patients with early [ 18 ] or long-standing disease [ 13 , 14 ]. The aforesaid studies may have missed relevant information about temporal changes in pain associated with the transition from early to long-standing IRDs.…”
Objective
To determine whether sociodemographic 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 rheumatoid arthritis (RA) and DESIR for early spondyloarthritis (SpA)). Data on pain was measured respectively at 13 and 9 occasions spanning 10 and 6 years of follow-up using Short-Form 36 bodily pain amongst 810 participants of ESPOIR, and 679 participants of DESIR. Linear mixed models were used to characterise 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 (RA, β=-3.8, p= 0.007; SpA, β=-6.0, p< 0.001) in both diseases, and Caucasians (β=-5.6, p= 0.021) in SpA presented with low pain early in the disease, with no changes throughout disease course.
Conclusion
Those older, females, non-Caucasians and lowly educated have worse pain in early and/or long-standing IRDs despite universally accessible health-care. Early identification of at-risk population and implementation of multi-disciplinary strategies may reduce patient-reported health outcome disparities.
“…In this study, education-based pain differences were present even in the early disease phase and persisted throughout. This is in accordance with antecedent studies that demonstrated higher pain in those with low education in both early [ 41 ] and long-standing disease [ 11 , 21 , 22 , 42 ]. Some showed a gradient in the association between years of education and pain [ 11 ].…”
Section: Discussionsupporting
confidence: 91%
“…In addition to disease severity [ 8 , 9 ], the treatment initiated [ 10 ] and individuals’ lifestyle and psychological health, it has been found that socio-demographic characteristics potentially contribute about 5–11% of the observed pain heterogeneity in IRDs [ 11 , 12 ]; older age [ 13 , 14 ], female sex [ 15–18 ], non-Caucasian ethnicity [ 19 ] and low socio-economic status [ 20 ] are associated with increased pain in IRDs; however, the consistency of this association throughout the disease course is unknown. Previous studies reporting associations between socio-demographic characteristics and pain in IRDs were based on cross-sectional [ 21 , 22 ] or longitudinal design that either did not account for non-linear evolution of pain in IRDs [ 11 ], were not based on repeatedly assessed pain measures [ 23 ], or were limited to patients with early [ 18 ] or long-standing disease [ 13 , 14 ]. The aforesaid studies may have missed relevant information about temporal changes in pain associated with the transition from early to long-standing IRDs.…”
Objective
To determine whether sociodemographic 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 rheumatoid arthritis (RA) and DESIR for early spondyloarthritis (SpA)). Data on pain was measured respectively at 13 and 9 occasions spanning 10 and 6 years of follow-up using Short-Form 36 bodily pain amongst 810 participants of ESPOIR, and 679 participants of DESIR. Linear mixed models were used to characterise 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 (RA, β=-3.8, p= 0.007; SpA, β=-6.0, p< 0.001) in both diseases, and Caucasians (β=-5.6, p= 0.021) in SpA presented with low pain early in the disease, with no changes throughout disease course.
Conclusion
Those older, females, non-Caucasians and lowly educated have worse pain in early and/or long-standing IRDs despite universally accessible health-care. Early identification of at-risk population and implementation of multi-disciplinary strategies may reduce patient-reported health outcome disparities.
“…Baldassari et al 27 recently reported that home ownership is associated with a lower risk of significant clinical activity of RA. In our study, home ownership was not categorised into the same factor as housing features resulting in HOUSES in our original study.…”
ObjectivesTo assess whether HOUSES (HOUsing-based index of socioeconomic status (SES)) is associated with risk of and mortality after rheumatoid arthritis (RA).DesignWe conducted a population-based case–control study which enrolled population-based RA cases and their controls without RA.SettingThe study was performed in Olmsted County, Minnesota.ParticipantsStudy 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 measureThe 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.ResultsOf 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.ConclusionsLower 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.
“…As a complement to pharmacologic strategies, rehabilitation is needed to address disability and functional limitation. Prior analyses in CLEAR indicated that socioeconomic disparities in disease activity, disability, and other self-reported health outcomes exist among African American adults with RA (15). Higher household income was associated with rehabilitation utilization in the prior 6 months, and current employment was associated with any prior rehabilitation utilization in this analysis (Table 2), which may further contribute to The results should be considered in light of several limitations.…”
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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