Association of functional outcome with both personal- and area-level socioeconomic inequalities in patients with inflammatory polyarthritis

Arthritis Rheum. 2009 Oct 15;61(10):1297-304. doi: 10.1002/art.24830.


Objective: To describe the relationship between baseline area- and person-level social inequalities and functional disability at 3 years in patients with early inflammatory polyarthritis (IP).

Methods: A total of 1,393 patients with new-onset IP were recruited and allocated an Index of Multiple Deprivation (IMD) 2004 score based on their area of residence, and a social class based on baseline self-reported occupation. Differences in the Health Assessment Questionnaire (HAQ) score at baseline and 3 years by IMD or social class were tested. The mean 3-year change in HAQ score was compared by IMD and social class, and interactions between these measures examined.

Results: Patients from more deprived areas had poorer 3-year HAQ outcome than those from less deprived areas (P = 0.019, adjusted for baseline HAQ score, age, sex, and symptom duration). The mean difference in HAQ change was most notable between the most deprived (IMD4) and least deprived areas (IMD1) (0.22; 95% confidence interval [95% CI] 0.11, 0.34). There was also a significant difference in HAQ score change between patients of the highest (SCI and II) and lowest social class (SCIV and V) (0.11; 95% CI 0.02, 0.20). For the mean (95% CI) 3-year change in HAQ score, a significant interaction exists between IMD score and social class and their association with HAQ scores (P = 0.001) to modify outcome: IMD1/SC I and II -0.23 (95% CI -0.40, -0.06) versus IMD 4/SC IV and V 0.15 (95% CI -0.05, 0.34).

Conclusion: Person- and area-level inequalities combine to modify outcome for rheumatoid arthritis. A person's social circumstance and residential environment have independent effects on outcome and are not just alternative measures of the same exposure.

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / economics*
  • Arthritis, Rheumatoid / physiopathology*
  • Arthritis, Rheumatoid / therapy
  • Cohort Studies
  • Disability Evaluation
  • Female
  • Health Status Disparities*
  • Humans
  • Male
  • Middle Aged
  • Recovery of Function
  • Severity of Illness Index
  • Social Class*
  • Surveys and Questionnaires