Is the relationship between deprivation and outcomes in rheumatoid arthritis mediated by body mass index? A longitudinal cohort study

Witkam, Rozemarijn; Gwinnutt, James M; Humphreys, Jennifer; Adebajo, Ade; Ahmed, Khalid; Al-Ansari, Atheer; Amarasena, Roshan; Bukhari, Marwan; Callan, Margaret; Chelliah, Easwaradhas G; Chinoy, Hector; Cooper, Annie; Dasgupta, Bhaskar; Davis, Martin J.; Galloway, James; Gough, Andrew; Green, Michael; Gullick, Nicola; Hamilton, Jennifer; Hassan, Waji; Hider, Samantha L.; Hyrich, Kimme L; Kamath, Sanjeet; Knight, Susan; Lane, Suzanne; Lee, Martin; Lévy, S.; Macphie, Lizzy; Marguerie, Christopher; Marshall, Tarnya; Mathews, Catherine; McKenna, Frank; Naz, Sophia; Perry, Mark; Pollard, Louise; Quilty, B; Robertson, Lindsay; Roy, Dipak; Sanders, Paul D.; Saravanan, Vadivelu; Scott, David G. I.; Smith, Gillian; Smith, Robert R.; Symmons, Deborah; Teh, Lee‐Suan; Viner, Nick; Verstappen, Suzanne

doi:10.1093/rheumatology/keac662

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…education, job type or housing). Some factors closely related to socioeconomic deprivation have been studied in detail as risk or prognostic factors in RA, such as smoking and obesity [ 2 , 3 ]. How such risk factors fit into the wider context of deprivation is unclear, for example whether the observed differences in RA outcomes would disappear if it were possible to eliminate smoking and obesity.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

et al. 2023

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Objective To investigate the association between socioeconomic deprivation and outcomes following TNF inhibitor (TNFi) treatment. Methods Individuals commencing their first TNFi in the British Society for Rheumatology Biologics Register for RA (BSRBR-RA) and Biologics in RA Genetics and Genomics Study Syndicate (BRAGGSS) cohort were included. Socioeconomic deprivation was proxied using the Index of Multiple Deprivation and categorised as 20% most deprived, middle 40%, 40% least deprived. DAS28-derived outcomes at 6 months (BSRBR-RA) and 3 months (BRAGGSS) were compared using regression models with the least deprived as referent. Risks of all-cause and cause-specific drug discontinuation were compared using Cox models in the BSRBR-RA. Additional analyses adjusted for lifestyle factors (e.g. smoking, BMI) as potential mediators. Results 16 085 individuals in the BSRBR-RA were included (mean age 56 years, 76% female), of whom 18%, 41% and 41% were in the most, middle and least deprived groups. Of 3459 included in BRAGGSS (mean age 57, 77% female), proportions were 22%, 36%, 41%, respectively. The most deprived group had 0.3-unit higher 6-month DAS28 (95%CI 0.22–0.37) and were less likely to achieve low disease activity (OR 0.76; 0.68–0.84) in unadjusted models. Results were similar for 3-month DAS28 (beta = 0.23, 95%CI 0.11–0.36) and low disease activity (OR 0.77; 0.63–0.94). The most deprived were more likely to discontinue treatment (HR 1.18; 1.12–1.25), driven by ineffectiveness rather than adverse events. Adjusted estimates were generally attenuated. Conclusion Socioeconomic deprivation is associated with reduced response to TNFi. Improvements in determinants of health other than lifestyle factors are needed to address socioeconomic inequities.

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Section: Introductionmentioning

confidence: 99%

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

et al. 2023

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Rheumatoid arthritis: thinking and understanding disease through a broader lens

Nikiphorou

Boonen

2023

Rheumatology

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Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Smith,

Whitson,

Merwin

et al. 2023

Front. Aging Neurosci.

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Interventions to preserve functional independence in older adults are critically needed to optimize ‘successful aging’ among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals’ ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to ‘top-down’ training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to ‘bottom-up’ approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

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Is the relationship between deprivation and outcomes in rheumatoid arthritis mediated by body mass index? A longitudinal cohort study

Cited by 3 publications

References 42 publications

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

Socioeconomic deprivation is associated with reduced response and lower treatment persistence with TNF inhibitors in rheumatoid arthritis

Rheumatoid arthritis: thinking and understanding disease through a broader lens

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

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