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Research ArticleRheumatoid Arthritis

The Association of Low Income with Functional Status and Disease Burden in German Patients with Rheumatoid Arthritis: Results of a Cross-sectional Questionnaire Survey Based on Claims Data

Johanna Callhoff, Andres Luque Ramos, Angela Zink, Falk Hoffmann and Katinka Albrecht
The Journal of Rheumatology June 2017, 44 (6) 766-772; DOI: https://doi.org/10.3899/jrheum.160966
Johanna Callhoff
From the Epidemiology Unit, German Rheumatism Research Centre; Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany.
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  • For correspondence: johanna.callhoff{at}drfz.de
Andres Luque Ramos
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Angela Zink
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Falk Hoffmann
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Katinka Albrecht
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    Figure 1.

    Flow chart of the study population. RA: rheumatoid arthritis.

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    Figure 2.

    Unadjusted analysis of self-reported functional status (FFbH), disease effect (RAID), and joint status (SJC and TJC) by household income categories. FFbH: Hannover functional status (range 0–100); RAID: Rheumatoid Arthritis Impact of the Disease (range 0–10); SJC: swollen joint count (range 0–48); TJC: tender joint count (range 0–50).

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    Table 1.

    Patient characteristics and patient-reported outcomes. All values are weighted according to the stratification.

    VariablesTotal, n = 1492Missing Values, n
    Patient characteristics
      Age, yrs, mean (95% CI)54.9 (54.6–55.3)0
      Female, %81.60
      Disease duration, yrs, mean (95% CI)14 (13.3–14.7)28
      In rheumatologic care, %74.18
      DMARD therapy, %52.120
      BMI, kg/m2, mean (95% CI)26.8 (26.4–27.1)16
      Smoking, ever, %43.717
    Socioeconomic variables
      Household income, €, %96
        < 150027.4
        1500–320051.8
        > 320020.7
      Education, yrs, %9
        ≤ 827.1
        9–1048
        > 1025
    Patient-reported disease outcomes
      FFbH, 0–100, mean (95% CI)73.2 (71.8–74.6)41
      RAID, 0–10, mean (95% CI)4.4 (4.3–4.6)23
      SJC, 0–48, mean (95% CI)7.4 (6.7–8.2)282
        Median (95% CI)3.2 (2.7–3.7)
      TJC, 0–50, mean (95% CI)12.3 (11.4–13.1)108
        Median (95% CI)7.8 (7–8.6)
    • DMARD: disease-modifying antirheumatic drugs; BMI: body mass index; FFbH: Hannover functional status questionnaire; RAID: Rheumatoid Arthritis Impact of Disease; SJC: swollen joint count; TJC: tender joint count.

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    Table 2.

    Effect of RA on work productivity outcomes, stratified by household income. All values are weighted according to the stratification. Values are % (95% CI).

    Work Productivity VariablesHousehold Income, €
    < 15001500–3200> 3200
    Having applied for disability pension18.1 (12.9–23.3)9.6 (6.7–12.4)6.9 (2.9–10.8)
    On sick leave for more than 6 weeks8.7 (4.8–12.7)3.5 (1.6–5.4)1.8 (0.2–3.4)
    Change of workplace9.1 (5.3–13)9.3 (6.5–12.2)5.1 (2.5–7.7)
    Less efficient at work58.5 (51.6–65.5)53.2 (48.3–58.1)57 (49.6–64.4)
    Fear of not being able to work until retirement30.5 (24.3–36.8)31.5 (26.9–36.1)27.9 (21.2–34.6)
    Working fewer hours14.2 (9.4–18.9)12.9 (9.3–16.4)17.3 (11.2–23.4)
    No influence of RA on professional activities*16.4 (11–21.7)22.4 (18.4–26.3)30 (23.2–36.9)
    • ↵* p < 0.05 in the Rao-Scott chi-square test comparing the proportion of persons in the income groups. For persons with low, medium, and high incomes, n = 22 (6.3%), 26 (3.6%), and 2 (0.7%), respectively, did not report on the influence of RA on their working life. Bold face indicates statistically significant influence on the outcome. RA: rheumatoid arthritis.

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    Table 3.

    Association between household income and self-reported disease outcomes: results from the multivariable linear regression models. All values are weighted according to the stratification. The models were mutually adjusted for all the variables in the table. Values are estimate (95% CI).

    VariableReferenceRAIDFFbHSJC
    Age, per 10 yrsPer 10 yrs−0.03 (−0.08 to 0.02)−2.43 (−2.79 to −2.06)0.49 (0.30–0.67)
    FemaleMale0.58 (0.50–0.66)−6.19 (−6.96 to −5.43)1.31 (0.91–1.72)
    BMI, kg/m2Per unit0.04 (0.04–0.05)−0.54 (−0.61 to −0.47)0.15 (0.11–0.19)
    Smoking, everNever0.01 (−0.09 to 0.10)−0.79 (−1.59 to 0.00)0.55 (0.14–0.96)
    Rheumatologic care, yesNo0.04 (−0.07 to 0.15)−1.95 (−2.85 to −1.06)−0.01 (−0.48 to 0.46)
    ≤ 8 yrs of education> 10 yrs0.74 (0.61–0.87)−4.07 (−5.26 to −2.87)0.33 (−0.20 to 0.87)
    9–10 yrs of education> 10 yrs0.39 (0.28–0.50)−2.89(−3.78 to −1.99)0.50 (0.07–0.92)
    Household income < €1500> € 32000.73 (0.59–0.86)−8.65 (−9.72 to −7.58)3.47 (2.86–4.08)
    Household income €1500–3200> € 32000.28 (0.16–0.39)−6.09 (−7.00 to −5.19)0.70 (0.41–1.29)
    Applied for disability pensionNo1.39 (1.23–1.55)−18.11 (−19.59 to −16.64)3.70 (2.90–4.50)
    On sick leave for > 6 weeksNo1.39 (1.18–1.60)−13.47 (−15.37 to −11.58)1.72 (0.59–2.84)
    Change of workplaceNo0.16 (0.01–0.30)−4.44 (−5.67 to −3.21)1.93 (1.03–2.82)
    Less efficient at workNo1.13 (1.04–1.22)−6.47 (−7.27 to −5.67)2.38 (1.98–2.78)
    Fear of not being able to work until retirementNo0.99 (0.90–1.09)−5.23 (−6.06 to −4.40)1.21 (0.77–1.64)
    Working fewer hoursNo0.03 (−0.09 to 0.15)0.26 (−0.84 to 1.35)−1.59 (−2.13 to −1.04)
    • Bold face indicates statistically significant influence on the outcome. RAID: Rheumatoid Arthritis Impact of the Disease (0–10); FFbH: Hannover functional status questionnaire (0–100); SJC: swollen joint count (0–48); BMI: body mass index.

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Vol. 44, Issue 6
1 Jun 2017
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The Association of Low Income with Functional Status and Disease Burden in German Patients with Rheumatoid Arthritis: Results of a Cross-sectional Questionnaire Survey Based on Claims Data
Johanna Callhoff, Andres Luque Ramos, Angela Zink, Falk Hoffmann, Katinka Albrecht
The Journal of Rheumatology Jun 2017, 44 (6) 766-772; DOI: 10.3899/jrheum.160966

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The Association of Low Income with Functional Status and Disease Burden in German Patients with Rheumatoid Arthritis: Results of a Cross-sectional Questionnaire Survey Based on Claims Data
Johanna Callhoff, Andres Luque Ramos, Angela Zink, Falk Hoffmann, Katinka Albrecht
The Journal of Rheumatology Jun 2017, 44 (6) 766-772; DOI: 10.3899/jrheum.160966
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Keywords

RHEUMATOID ARTHRITIS
EPIDEMIOLOGY
HEALTHCARE
DISEASE BURDEN

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