Review of literature studying socioeconomic status in rheumatoid arthritis (RA), early RA, and early inflammatory arthritis (EIA). Low SES is associated with worse outcomes.
| Author, Year, Study Type | Definition of SES | Patient Population | Mean Followup | Mortality | Erosions on Radiograph | HAQ | Outcomes Other Outcomes | Pain | Other Findings |
|---|---|---|---|---|---|---|---|---|---|
| Maiden1 (1999) retrospective cohort | Carstairs score17 | n = 200 | None | ↑ | |||||
| ERAS2 (2000) prospective cohort | Difference between Carstairs score17 fifth percentile and 95th percentile | n = 869 with EIA < 2 yrs, prior to DMARD | 3 yrs | Not significant at 3 yrs | Not significant | Baseline: OR 1.87 for an above- median HAQ. 3 yrs: OR 1.74 adjusted for age, sex, treatment center, baseline HAQ | Baseline: Not OR 1.77 for an above- median joint score. Also worse at 3 yrs | significant | Worse functional class at 3 yrs |
| ERAS2 (2000) prospective cohort | Education (no high school vs more education) | n = 869 with EIA < 2 yrs | 3 yrs | Not significant at 3 yrs | N/A | Worse at baseline and 3 yrs in low education | Worse at 3 yrs in low education | Worse at baseline and 3 yrs in low education | |
| Jacobi3 (2003) prospective cohort | Education (less than high school, vs high school completed vs postsecondary school) | n = 878 with RA disease duration 0–15 yrs | 2 yrs | N/A | N/A | For disease duration 0–5 yrs, duration OR for HAQ ≥ 0.5 in low SES: 2.2. No significant difference on followup. | For disease 0–5 yrs, OR for DAS28 > 3.3 in low SES: 3.3. No significant difference on followup. | N/A | In ERA: Less use of allied healthcare in low SES, more depression and worse QoL. No differences in RA duration 5–15 yrs. At 2 yrs followup low SES group significantly improved QoL |
| Harrison5 (2005) retrospective cohort | Townsend score18 | n = 466 with RA | 3 yrs | No significant difference at 3 yrs | No significant difference at baseline | Worse at baseline and 3 yrs in low SES at | DAS28 worse at baseline, not 3 yrs in low SES | Worse at baseline in low SES | Worse baseline: SF-36 MCS, EQ-5D utility score in low SES |
| Harrison6 (2009) retrospective cohort | IMD19 and social class (occupation) | n = 1393 with EIA | 3 yrs | N/A | No differences across social classes, but significant change in HAQ over 3 yrs across IMD quartiles. No significant difference across social classes | Differences in SJC and TJC over 3 yrs across social classes | N/A | ||
| Massardo9 (2012) prospective cohort | Modified Graffar method20 | n = 1093 with EIA in Latin America | None | N/A | Not significant | Significantly higher HAQ in low SES | Significantly higher DAS28 in low SES score | Significantly higher pain in low SES | Widowed, separated, divorced status associated with worse HAQ. PtGA, PGA, and ESR significantly worse in low SES |
| Camacho8 (2012) prospective cohort | IMD19 | n = 553 with EIA | None | N/A | N/A | Significantly higher HAQ in low SES | Significantly higher DAS28 in low SES | N/A | Learned helplessness mediated the SES effect on outcomes |
↑ = increased. ERA: early rheumatoid arthritis; QoL: quality of life; IMD: Index of Multiple Deprivation; DMARD: disease-modifying antirheumatic drug; SES: socioeconomic status; HAQ: Health Assessment Questionnaire; MCS: mental component score; SF-36: Medical Outcomes Study Short Form-36; DAS28: 28-joint Disease Activity Score; PtGA: patient’s global assessment; PGA: physician’s global assessment; N/A: not applicable; ESR: erythrocyte sedimentation rate; EQ-5D: EuroQol questionnaire; SJC: swollen joint count; TJC: tender joint count.