Socioeconomic Status and Medication Use in Rheumatoid Arthritis: A Scoping Review

Abstract

Objective Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. Differences in medication use may partly explain this association. A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain. Methods Medline, Embase, and PsychInfo were searched from their inception until February 2022 for studies that assessed SES and medication use as an outcome variable. Data was extracted on the use of specific SES measures, medication use, and whether differences in SES variables were associated with differences in medication use. Results We identified 2,103 studies, of which 81 were selected for inclusion. Included studies originated most frequently from the US (42%); the mean ± SD age of participants was 55.9 ± 6.8 years, and most were female (75%). Studies measured a median of 4 SES variables (interquartile range 3–6), with educational, area‐level SES, and income being the most frequent measurements used. Patients' race and/or ethnicity were documented by 34 studies. Studies primarily assessed the likelihood of prescription of disease‐modifying antirheumatic drugs or dispensation, medication adherence, or treatment delays. A majority of studies documented at least 1 SES measure associated with a difference in medication use. Conclusion There is some evidence that SES affects use of medications in patients with RA; however, multiple definitions of SES have been utilized, making comparisons between studies difficult. Prospective studies with consistently defined SES will be needed to determine whether differences in medication use accounts for the poorer outcomes experienced by patients of lower SES.

Patient trust, quality communication, and medication adherence in rheumatoid arthritis patients highly affected by social determinants of health

“…This study identified a high‐risk subgroup of patients with RA greatly affected by social determinants of health and who have unique relational and clinical characteristics which could be used to craft multilevel inventions to address the adverse health outcomes of RA patients in this at‐risk group (Constantinescu et al., 2009; Greenberg et al., 2013; Hollick & Macfarlane, 2021; Spruill et al., 2014). Specifically, non‐Hispanic Black, Hispanic, and rural‐dwelling patients with RA are significantly less likely to achieve low disease activity and disease remission (Greenberg et al., 2013; Hollick & Macfarlane, 2021; Russell et al., 2023). Racial minorities and those residing in low‐income regions, such as the patients in this study that are from rural areas of the state, have also been found to have lower medication adherence (Chu et al., 2015; Kentucky Center for Statistics, 2016; Russell et al., 2023).…”

“…Specifically, non‐Hispanic Black, Hispanic, and rural‐dwelling patients with RA are significantly less likely to achieve low disease activity and disease remission (Greenberg et al., 2013; Hollick & Macfarlane, 2021; Russell et al., 2023). Racial minorities and those residing in low‐income regions, such as the patients in this study that are from rural areas of the state, have also been found to have lower medication adherence (Chu et al., 2015; Kentucky Center for Statistics, 2016; Russell et al., 2023). Building on the work reported in the literature broadly, findings from this study support the relationship between trust in the provider and race/ethnicity with medication adherence (Balsa et al., 2022; Salt & Frazier, 2011; Salt, Wiggins, Harrington, Rayens, & Lohr, 2022).…”

Uptake and Spending on Biosimilar Infliximab and Etanercept After New Start and Switching Policies in Canada: An Interrupted Time Series Analysis

“…A recent large systematic review of 81 studies of rheumatoid arthritis, medicine use, and socioeconomic status found variable relationships between income and medication use. For instance, lower income was associated with reduced adherence in Canada, but the reverse was true in the US (26). However, we only detected income quintile–based variation in use among infliximab switching and not with respect to etanercept.…”

Understanding the psychosocial determinants of effective disease management in rheumatoid arthritis to prevent persistently active disease: a qualitative study

“…14 15 Epidemiological studies demonstrate social factors (eg, education, socioeconomic status, or access to local resources and amenities) are associated with increased disease activity, pain, poorer functioning, treatment help-seeking, increased treatment waiting times and mortality. [16][17][18][19][20] Living in an area with high poverty levels can impact functional disability and disease activity among people with inflammatory arthritis due to the limited availability of resources needed to achieve optimal health. 21 22 Additionally, adults with RA have a lower likelihood of being employed or remaining in work compared with adults without RA.…”