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

Harrison, Mark J.; Farragher, Tracey M.; Clarke-Cornwell, Alexandra M.; Manning, Stephanie C.; Bunn, Diane K.; Symmons, Deborah P.M.

Abstract

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.

Citation

Harrison, M. J., Farragher, T. M., Clarke-Cornwell, A. M., Manning, S. C., Bunn, D. K., & Symmons, D. P. (2009). Association of functional outcome with both personal- and area-level socioeconomic inequalities in patients with inflammatory polyarthritis. Arthritis Care and Research, 61(10), 1297-1304. https://doi.org/10.1002/art.24830

• Journal Article Type: Article
• Publication Date: Sep 29, 2009
• Deposit Date: Sep 23, 2023
• Journal: Arthritis Care and Research
• Print ISSN: 2151-464X
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 61
• Issue: 10
• Pages: 1297-1304
• DOI: https://doi.org/10.1002/art.24830