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Zhu L, Moreland LW, Ascherman D. Cross-sectional association between social and demographic factors and disease activity in rheumatoid arthritis. BMC Rheumatol 2024; 8:2. [PMID: 38238799 PMCID: PMC10797737 DOI: 10.1186/s41927-023-00371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/23/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND This study aimed to assess the association between social factors, demographic parameters, and disease activity among rheumatoid arthritis (RA) patients. METHODS The University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry was used for this study and included patients meeting 1987 ACR criteria for RA enrolled between 2010-2015. The registry collected clinical and laboratory data at each visit, permitting the calculation of disease activity measures that included Disease Activity 28-C Reactive Protein (DAS28-CRP). The current study was conducted as a cross-sectional study in which baseline data were used to construct multiple logistic regression models assessing the relationship between disease activity measures (DAS28-CRP), functional capacity (health assessment questionnaire (HAQ)), selected demographic and social factors (occupation, education, income, marital status, race, gender, age, and BMI), and clinical/laboratory variables. RESULTS The analyses included 729 patients with baseline DAS28-CRP and social/demographic data. The mean age at enrollment was 59.5 (Standard Deviation (SD) = 12.7) years, 78% were female, and the median RA disease duration was 9.8 (Interquartile Range (IQR): 3.7, 19.1) years. We dichotomized the DAS28-CRP score and defined scores above or below 3.1 as high versus low RA disease activity. Most patients with high RA disease activity (N = 326, 45%) had less than a college degree (70%), were not working/retired/disabled (71%), and had an annual income under $50 K (55%). We found that higher body mass index (BMI) (Odds Ratio (OR) = 1.04, 95% CI: 1.01-1.08), longer disease duration (> 2 and < 10 years versus ≤ 2 years of disease) (OR = 0.45, 95% CI: 0.25-0.78), and being retired (OR = 1.74, 95% CI: 1.02-2.98) were associated with RA disease activity. CONCLUSION Increased RA activity may be associated with various social factors, potentially leading to more severe and debilitating disease outcomes. These findings provide evidence to support efforts to monitor disparities and achieve health equity in RA.
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Affiliation(s)
- Lei Zhu
- Division of Rheumatology and Clinical Immunology, School of Medicine, University of Pittsburgh, BST S723, 200 Lothrop Street, Pittsburgh, PA, 15261, USA
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Larry W Moreland
- Division of Rheumatology, School of Medicine, and Orthopedics, University of Colorado, Aurora, CO, USA
| | - Dana Ascherman
- Division of Rheumatology and Clinical Immunology, School of Medicine, University of Pittsburgh, BST S723, 200 Lothrop Street, Pittsburgh, PA, 15261, USA.
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The burden of rheumatoid arthritis in the Middle East and North Africa region, 1990-2019. Sci Rep 2022; 12:19297. [PMID: 36369238 PMCID: PMC9652423 DOI: 10.1038/s41598-022-22310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. The present study reported the burden of RA in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex, and socio-demographic index (SDI). Publicly available data from the Global Burden of Disease (GBD) 2019 study was used to report the modelled point prevalence, annual incidence, and disability-adjusted life-years (DALYs) of RA, as counts and age-standardised rates with their corresponding 95% uncertainty intervals (UIs). In 2019, RA had an age-standardised point prevalence of 120.6 per 100,000 population (107.0-135.7) and an annual incidence rate of 5.9 (5.2-6.6) in MENA, which have increased 28.3% and 25.2%, respectively, since 1990. In 2019, the number of DALYs due to RA in the region was 103.6 thousand (74.2-136.7), with an age-standardised rate of 19.0 (13.9-24.9) DALYs per 100,000 population, which has increased by 18.6% since 1990 (6.7-28.2). The highest point prevalence was found in females aged 50-54, and in males aged 45-49. The highest number of DALYs was observed in the 50-54 age group. The MENA DALY rate was lower than the global rate (19.0 vs. 39.6 per 100,000), but the rate was higher in all age groups in 2019, when compared with 1990. In addition, from 1990 to 2019 an increased burden from RA was associated with an increase in SDI. In line with global trends, the burden of RA in the MENA region showed a steady increase from 1990 to 2019. This highlights the increasing need for updating the available health data to design more accurate guidelines to enable the early detection and treatment of RA in the MENA countries.
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Dey M, Busby A, Elwell H, Lempp H, Pratt A, Young A, Isaacs J, Nikiphorou E. Association between social deprivation and disease activity in rheumatoid arthritis: a systematic literature review. RMD Open 2022; 8:rmdopen-2021-002058. [PMID: 35450954 PMCID: PMC9024227 DOI: 10.1136/rmdopen-2021-002058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Physical and mental illnesses are driven by ethnicity, social, environmental and economic determinants. Novel theoretical frameworks in rheumatoid arthritis (RA) focus on links and adverse interactions between and within biological and social factors. This review aimed to summarise associations between socioeconomic status (SES) and RA disease activity, and implications for future research. Articles studying the association between SES and RA disease activity were identified, from 1946 until March 2021. The research question was: Is there an association between social deprivation and disease activity in people with RA? Articles meeting inclusion criteria were examined by one author, with 10% screened at abstract and full paper stage by a second author. Disagreements were resolved with input from a third reviewer. Information was extracted on definition/measure of SES, ethnicity, education, employment, comorbidities, disease activity and presence/absence of association between SES and disease activity. Initially, 1750 articles were identified, with 30 articles ultimately included. SES definition varied markedly—10 articles used a formal scale and most used educational attainment as a proxy. Most studies controlled for lifestyle factors including smoking and body mass index, and comorbidities. Twenty-five articles concluded an association between SES and RA disease activity; two were unclear; three found no association. We have demonstrated the association between low SES and worse RA outcomes. There is a need for further research into the mechanisms underpinning this, including application of mixed-methods methodology and consideration of syndemic frameworks to understand bio–bio and bio–social interactions, to examine disease drivers and outcomes holistically.
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Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, Brownlow Hill, University of Liverpool, Liverpool, UK .,Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Amanda Busby
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London, UK
| | - Heidi Lempp
- Academic Department of Rheumatology, Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Arthur Pratt
- Translational and Clinical Research Institute, Framlington Place, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Adam Young
- Centre for Health Services and Clinical Research, Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - John Isaacs
- Translational and Clinical Research Institute, Framlington Place, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK.,Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Elena Nikiphorou
- Academic Department of Rheumatology, Department of Inflammation Biology, Centre for Rheumatic Diseases, King's College London, London, UK.,Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
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Alnakhi WK, Segal JB, Frick KD, Hussin A, Ahmed S, Morlock L. Treatment destinations and visit frequencies for patients seeking medical treatment overseas from the United Arab Emirates: results from Dubai Health Authority reporting during 2009-2016. Trop Dis Travel Med Vaccines 2019; 5:10. [PMID: 31308954 PMCID: PMC6604140 DOI: 10.1186/s40794-019-0086-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Each year, the Dubai Health Authority (DHA) spends millions of dollars to cover the costs of United Arab Emirates (UAE) nationals seeking healthcare overseas. Patients may travel overseas to seek an array of treatments. It is important to analyze the number of trips and treatment destinations for patients travelling overseas to provide baseline information for the DHA to improve polices and strategies related to overseas treatment for UAE nationals. METHODS Administrative data were obtained from the DHA for UAE nationals who sought medical treatment overseas during 2009-2016. We examined the number of trips and treatment destinations by medical specialty, age, gender, years of travel and travel seasons. Multinomial logistic and negative binomial regression models were used to assess the relationships of the treatment destinations and number of trips, respectively, with the key variables of interest. RESULTS The study included data from 6557 UAE nationals. The top three treatment destinations were Germany (46%), the UK (19%) and Thailand (14%). The most common medical specialties were orthopedic surgery (13%), oncology (13%) and neurosurgery (10%). Oncology had the highest expected number of trips adjusted for a number of covariates (IRR 1.34, 95% CI: 1.24-1.44). Regarding destination variation, patients had a lower relative risk ratio of seeking healthcare in Germany in the winter (RRR 0.68, 95% CI: 0.57-0.80). Endocrinology was the most common medical specialty sought in the UK (RRR 3.36, 95% CI: 2.01-5.60). CONCLUSIONS This is the first study to systematically examine the current practice of medical treatment overseas among UAE nationals. The results demonstrate that treatment destinations, medical specialties for which treatment was sought, age, gender and travel season are significant factors in understanding overseas travel for medical care. The study can guide the DHA in collecting more data for further research that may lead to policy-relevant information about sending patients to the best-quality treatment choices at an optimal cost.
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Affiliation(s)
- Wafa K. Alnakhi
- Department of Health Policy and Management Bloomberg School of Public Health, Baltimore, USA
| | - Jodi B. Segal
- School of Medicine Johns Hopkins University, Baltimore, USA
| | - Kevin D. Frick
- Carey Business School Johns Hopkins University, Baltimore, USA
| | | | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health Bloomberg School of Public Health, Baltimore, USA
| | - Laura Morlock
- Department of Health Policy and Management Bloomberg School of Public Health, Baltimore, USA
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Dargham SR, Zahirovic S, Hammoudeh M, Al Emadi S, Masri BK, Halabi H, Badsha H, Uthman I, Mahfoud ZR, Ashour H, Gad El Haq W, Bayoumy K, Kapiri M, Saxena R, Plenge RM, Kazkaz L, Arayssi T. Epidemiology and treatment patterns of rheumatoid arthritis in a large cohort of Arab patients. PLoS One 2018; 13:e0208240. [PMID: 30566451 PMCID: PMC6300286 DOI: 10.1371/journal.pone.0208240] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES There is limited information on the epidemiology and treatment patterns of rheumatoid arthritis (RA) across the Arab region. We aim in this study to describe the demographic characteristics, clinical profile, and treatment patterns of patients of Arab ancestry with RA. METHODS This is a cross sectional study of 895 patients with established rheumatoid arthritis enrolled from five sites (Jordan, Lebanon, Qatar, Kingdom of Saudi Arabia (KSA), and United Arab Emirates). Demographic characteristics, clinical profile, and treatment patterns are compared between the five countries. RESULTS The majority of our patients are women, have an average disease duration of 10 years, are married and non-smokers, with completed secondary education. We report a high (>80%) ever-use of methotrexate (MTX) and steroids among our RA population, while the ever-use of disease modifying anti-rheumatic drugs (DMARDs) and TNF-inhibitors average around 67% and 33%, respectively. There are variations in RA treatment use between the five country sites. Highest utilization of steroids is identified in Jordan and KSA (p-value < 0.001), while the highest ever-use of TNF-inhibitors is reported in KSA (p-value < 0.001). CONCLUSION Disparities in usage of RA treatments among Arab patients are noted across the five countries. National gross domestic product (GDP), as well as some other unique features in each country likely affect these. Developing treatment guidelines specific to this region could contribute in delivering standardized therapies to RA patients.
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Affiliation(s)
| | | | | | | | | | - Hussein Halabi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Humeira Badsha
- Dr. Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | - Imad Uthman
- American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Richa Saxena
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Broad Institute, Cambridge, Massachusetts, United States of America
| | - Robert M. Plenge
- Broad Institute, Cambridge, Massachusetts, United States of America
- Merck Research Laboratories, Boston, Massachusetts, United States of America
| | | | - Thurayya Arayssi
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- * E-mail:
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