Socioeconomic Status Linked to Disparities in RA Care, Management

Geraldo da Rocha Castelar Pinheiro, MD

Credit: Brazilian Academy of Rheumatology

Findings from a recent study are providing clinicians with an overview of distinct challenges posed by various socioeconomic factors potentially impacting therapeutic outcomes in patients with rheumatoid arthritis (RA).¹

The study leveraged data from the REAL study, which included patients with RA across 11 public health care centers in different geographic regions of Brazil, and found patients from lower socioeconomic classes had different prescription rates and worse Simple Disease Activity Index (SDAI) outcomes compared to patients of higher socioeconomic status.¹

“The impact of RA extends beyond physical discomfort, influencing various aspects of a person’s life,” Geraldo da Rocha Castelar Pinheiro, MD, professor of rheumatology at Rio de Janeiro State University in Brazil, and colleagues wrote.¹ “Patients from diverse socioeconomic backgrounds may face distinct challenges in adhering to treatment plans, accessing specialized medical care and affording necessary medications. These disparities can impact the overall response to therapy, disease progression, and the quality of life experienced by individuals with RA.”

According to the World Health Organization, in 2019, 18 million people worldwide were living with RA, predominantly affecting women (70%) and those older than 55 years of age (55%). RA is chronic and may worsen over time without treatment, potentially leading to severe damage to the joint and surrounding tissue and making it difficult to perform daily activities. Given the importance of prompt diagnosis and appropriate treatment, understanding the different factors influencing patients’ ability to manage their RA is important for improving outcomes.²

To assess the impact of socioeconomic factors on therapeutic outcomes in patients with RA, investigators collected data from the REAL study, a prospective observational cohort study of patients with RA from 11 public healthcare centers across Brazil. The study described clinical, laboratory, radiographic, therapeutic, and quality of life characteristics.¹

In the present analysis, patients were divided into 2 groups based on their socioeconomic status as determined by the Brazilian Economic Classification Criterion, a scoring system that accounts for variables such as the number of household electrical appliances, the education level of the householder, and access to public services. The score range is stratified from A to E, with Class A and Class B considered to be upper class, Class C as middle class, and Class D and Class E as lower class.¹

In total, investigators analyzed data for 1101 patients. Among the cohort, 89.4% of patients were female; 56.9% were White; 47.3% were using corticosteroids; 35.7% were on biologic DMARD therapy; and 66.2% were using methotrexate.¹

Regarding socioeconomic status, 1.4% of patients were classified to Class A; 22% to Class B; 58% to Class C; and 17.9% to Class D/E. Investigators noted 20.9% of patients across the entire study population were rheumatoid factor negative while 22.1% and 55.4% had low and high-titer positive RF, respectively. Regarding the SDAI, 16% of patients were in remission, 27.6% had low disease activity, 27.8% had moderate disease activity, and 13% had high disease activity. Additionally, 12.4% and 15.8% of patients achieved the Boolean criteria for remission 1.0 and 2.0, respectively.¹

When looking at these variables by socioeconomic class, investigators noted patients from Classes A and B had lower prescription rates of methotrexate (58.8%) and higher prescription rates of biologics (45.5%) compared to patients from lower socioeconomic classes (68.5% and 32.7%, respectively; P = .004 and P = .000, respectively).¹

Individuals from higher socioeconomic classes also demonstrated better outcomes in the SDAI, with a greater frequency of achieving the Boolean remission criteria 1.0 (23.1%) and 2.0 (28.1%) versus patients from lower socioeconomic classes (12.0% and 15.8%; both P = .000). Patients from Class A and B also had statistically significantly lower Health Assessment Questionnaire (0.836 vs 0.976; P = .011) and short-form 6-dimension (0.342 vs 0.375; P = .001) scores compared to those from Classes C, D, and E.¹

“These findings highlight the complex interplay between socioeconomic factors, disease characteristics, and treatment outcomes in the studied population, emphasizing the need for a comprehensive approach to address disparities in RA management across different socioeconomic strata,” investigators concluded.¹

References:

1. ^{De Carvalho Sacilotto N, Albuquerque C, Neubarth Giorgi RD, et al. IMPACT OF SOCIOECONOMIC CLASS ON MANAGEMENT OUTCOMES OF RHEUMATOID ARTHRITIS UNDER REAL LIFE CONDITIONS. EULAR. 10.1136/annrheumdis-2024-eular.3238}
2. ^{World Health Organization. Rheumatoid arthritis. Newsroom. June 28, 2023. Accessed June 25, 2024. https://www.who.int/news-room/fact-sheets/detail/rheumatoid-arthritis}