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Eirey SM, San-Roman-Montero J, Gil de Miguel A, Rojo R, López Sánchez AF. Effect of the 2008 economic crisis on oral health in Spain: analysis of serial cross-sectional, population-based health surveys. BMJ Open 2022; 12:e061947. [PMID: 36517101 PMCID: PMC9756153 DOI: 10.1136/bmjopen-2022-061947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate the impact of the economic crisis on the oral health of individuals in Spain based on variables including sex, unemployment, social class and educational level. DESIGN This was an analysis of serial cross-sectional, population-based health surveys conducted before the crisis (2003 and 2006) and during the crisis (2011, 2014 and 2017). SETTING National Health Surveys of Spain and the European Health Survey in Spain.ParticipantsA total of 189 543 participants were recruited. OUTCOME MEASURES The independent variables were sex, employment, social class and educational level. The dependent variables were related to oral health. Descriptive statistics, χ2 tests and the Cochran-Mantel-Haenszel test were performed. RESULTS The results showed that there were differences (p<0.001) in all oral health indicators before and after the crisis. Compared with the precrisis period, men had a higher probability of tooth extractions (OR 1.41, 95% CI 1.37 to 1.45), dental fillings (OR 1.30, 95% CI 1.27 to 1.34), prostheses (OR 1.04, 95% CI 1.01 to 1.07) and missing teeth (OR 1.35, 95% CI 1.31 to 1.39). Unemployed individuals were more likely to have dental caries (OR 1.08, 95% CI 1.00 to 1.16) and missing teeth (OR 1.36, 95% CI 1.27 to 1.46). Working class individuals had a higher probability of tooth extractions (OR 1.63, 95% CI 1.59 to 1.67), bleeding gums (OR 1.04, 95% CI 1.01 to 1.07), prostheses (OR 1.05, 95% CI 1.02 to 1.07) and missing teeth (OR 1.36, 95% CI 1.33 to 1.39). Participants with a basic or intermediate level of education had a higher probability of dental mobility (OR 1.13, 95% CI 1.07 to 1.19), prostheses (OR 1.11, 95% CI 1.08 to 1.14) and missing teeth (OR 1.42, 95% CI 1.38 to 1.46). CONCLUSIONS The economic crisis affected the oral health of the Spanish population, with a more significant deterioration among men, working class individuals and unemployed individuals.
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Affiliation(s)
- Silvia Méndez Eirey
- Doctoral Program in Health Sciences, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Jesús San-Roman-Montero
- Department of Medicine Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Angel Gil de Miguel
- Department of Medicine Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Rosa Rojo
- Faculty of Dentistry, Universidad Alfonso X el Sabio, Villanueva de la Canada, Spain
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Donahue KE, Schulman ER, Gartlehner G, Jonas BL, Coker-Schwimmer E, Patel SV, Weber RP, Bann CM, Viswanathan M. Comparative Effectiveness of Combining MTX with Biologic Drug Therapy Versus Either MTX or Biologics Alone for Early Rheumatoid Arthritis in Adults: a Systematic Review and Network Meta-analysis. J Gen Intern Med 2019; 34:2232-2245. [PMID: 31388915 PMCID: PMC6816735 DOI: 10.1007/s11606-019-05230-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/13/2019] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Comparative effectiveness of early rheumatoid arthritis (RA) treatments remains uncertain. PURPOSE Compare benefits and harms of biologic drug therapies for adults with early RA within 1 year of diagnosis. DATA SOURCES English language articles from the 2012 review to October 2017 identified through MEDLINE, Cochrane Library and International Pharmaceutical Abstracts, gray literature, expert recommendations, reference lists of published literature, and supplemental evidence data requests. STUDY SELECTION Two persons independently selected studies based on predefined inclusion criteria. DATA EXTRACTION One reviewer extracted data; a second reviewer checked accuracy. Two independent reviewers assigned risk of bias ratings. DATA SYNTHESIS We identified 22 eligible studies with 9934 participants. Combination therapy with tumor necrosis factor (TNF) or non-TNF biologics plus methotrexate (MTX) improved disease control, remission, and functional capacity compared with monotherapy of either MTX or a biologic. Network meta-analyses found higher ACR50 response (50% improvement) for combination therapy of biologic plus MTX than for MTX monotherapy (relative risk range 1.20 [95% confidence interval (CI), 1.04 to 1.38] to 1.57 [95% CI, 1.30 to 1.88]). No significant differences emerged between treatment discontinuation rates because of adverse events or serious adverse events. Subgroup data (disease activity, prior therapy, demographics, serious conditions) were limited. LIMITATIONS Trials enrolled almost exclusively selected populations with high disease activity. Network meta-analyses were derived from indirect comparisons relative to MTX due to the dearth of head-to-head studies comparing interventions. No eligible data on biosimilars were found. CONCLUSIONS Qualitative and network meta-analyses suggest that the combination of MTX with TNF or non-TNF biologics reduces disease activity and improves remission when compared with MTX monotherapy. Overall adverse event and discontinuation rates were similar between treatment groups. REGISTRATION PROSPERO (available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017079260 ).
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Affiliation(s)
- Katrina E Donahue
- University of North Carolina Department of Family Medicine, Chapel Hill, NC, USA. .,Cecil G Sheps Center for Health Services Research, Chapel Hill, NC, USA.
| | | | - Gerald Gartlehner
- RTI International, Research Triangle Park, NC, USA.,Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria
| | - Beth L Jonas
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
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Shanahan EM. Work disability and musculoskeletal disease. Int J Rheum Dis 2019; 22:965-966. [PMID: 31250559 DOI: 10.1111/1756-185x.13600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- E Michael Shanahan
- Rheumatology Department, Flinders Medical Centre, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Tanaka Y, Kameda H, Saito K, Kaneko Y, Tanaka E, Yasuda S, Tamura N, Fujio K, Fujii T, Kojima T, Anzai T, Hamada C, Fujino Y, Matsuda S, Kohsaka H. Effect of subcutaneous tocilizumab treatment on work/housework status in biologic-naïve rheumatoid arthritis patients using inverse probability of treatment weighting: FIRST ACT-SC study. Arthritis Res Ther 2018; 20:151. [PMID: 30029613 PMCID: PMC6053758 DOI: 10.1186/s13075-018-1647-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Following the onset of rheumatoid arthritis (RA), patients experience a functional decline caused by various joint symptoms which affects their activities of daily living and can lead to reduced work productivity. We evaluated the effect of a 52-week treatment with tocilizumab by subcutaneous injection (TCZ-SC) among biologic-naive Japanese house workers (HWs) and paid workers (PWs) with RA in a real-world clinical practice. METHODS This multicenter, observational, prospective study enrolled 377 and 347 RA patients into TCZ-SC and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs)-alone groups, respectively. The primary endpoint was the change in percentage of overall work impairment (OWI) among PWs at week 52 assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI). Inverse probability of treatment weighting analyses were used to compare treatments. The Work Functioning Impairment Scale, disease activity, quality of life (QOL) measures, and safety were also assessed. RESULTS The weighted change in OWI from baseline for PWs was -18.9% (TCZ-SC group) and -19.0% (csDMARDs group) at week 52, without a significant between-group difference (adjusted treatment difference 0.1, 95% confidence interval (CI) -6.3 to 6.5; P = 0.978). Changes in WPAI activity impairment in the overall group (between-group difference -6.4, 95% CI -10.7 to -2.2; P = 0.003) and HWs (-9.5, 95% CI - 16.0 to -2.9; P = 0.005) were significantly better with TCZ-SC than with csDMARDs at week 52. TCZ-SC-treated HWs showed significant improvement in all QOL assessments (Frenchay Activities Index, EuroQol 5 Dimension (EQ-5D), Japanese Health Assessment Questionnaire Disability Index (HAQ-DI), and 6-item Kessler scale (K6)) at week 52; PWs did not show any between-group differences for these QOL measures. Disease activity (Disease Activity Score 28-erythrocyte sedimentation rate, Clinical Disease Activity Index, and Simplified Disease Activity Index) and QOL measures (EQ-5D, HAQ-DI, and K6) improved over time in the overall group. No new safety concerns were raised with TCZ-SC. CONCLUSIONS Despite the lack of differences in OWI between groups at week 52, the overall group (particularly HWs) receiving TCZ-SC in addition to csDMARDs showed significant improvements in activity impairment, disease activity, and QOL versus those receiving csDMARDs alone. This study may promote the evaluation of work productivity improvements in HWs and PWs by RA treatment.
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Affiliation(s)
- Yoshiya Tanaka
- University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-0804, Japan.
| | - Hideto Kameda
- Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Kazuyoshi Saito
- University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-0804, Japan.,Tobata General Hospital, 1-3-33 Fukuryugi, Tobata-ku, Kitakyushu, Fukuoka, 804-0025, Japan
| | - Yuko Kaneko
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eiichi Tanaka
- Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Shinsuke Yasuda
- Hokkaido University, N15, W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Naoto Tamura
- Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Keishi Fujio
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan
| | - Takao Fujii
- Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Toshihisa Kojima
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tatsuhiko Anzai
- EPS Corporation, 6-29 Shinogawamachi, Shinjuku-ku, Tokyo, 162-0814, Japan
| | - Chikuma Hamada
- Tokyo University of Science, 6-3-1 Niijuku, Katsuhika-ku, Tokyo, 125-8585, Japan
| | - Yoshihisa Fujino
- University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-0804, Japan
| | - Shinya Matsuda
- University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-0804, Japan
| | - Hitoshi Kohsaka
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Tillett W, Shaddick G, Jobling A, Askari A, Cooper A, Creamer P, Clunie G, Helliwell PS, James J, Kay L, Korendowych E, Lane S, Packham J, Shaban R, Thomas ML, Williamson L, McHugh N. Effect of anti-TNF and conventional synthetic disease-modifying anti-rheumatic drug treatment on work disability and clinical outcome in a multicentre observational cohort study of psoriatic arthritis. Rheumatology (Oxford) 2017; 56:603-612. [PMID: 28013211 DOI: 10.1093/rheumatology/kew433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Indexed: 01/18/2023] Open
Abstract
Objectives To determine the effect of medical treatment on work disability in patients with active PsA in a real-world setting. Methods Four hundred patients with active PsA commencing or switching to anti-TNF or conventional synthetic DMARD (csDMARD) were recruited to a multicentre UK prospective observational cohort study. Work disability was measured using the work productivity and activity-specific health problem instrument and peripheral joint activity was measured with the disease activity in PsA composite measure. Results Four hundred patients were recruited, of whom 229 (57.25%) were working (of any age). Sixty-two patients of working age (24%) were unemployed. At 6 months there was a 10% improvement in presenteeism ( P = 0.007) and a 15% improvement in work productivity ( P = 0.001) among working patients commenced on csDMARDs ( n = 164) vs a larger and more rapid 30% improvement in presenteeism ( P < 0.001) and 40% improvement in work productivity ( P < 0.001) among those commenced on anti-TNF therapy ( n = 65). Clinical response was poor among patients commenced on a csDMARD ( n = 272), with an 8.4 point improvement in disease activity in PsA ( P < 0.001) vs those commenced on anti-TNF therapy ( n = 121), who had a 36.8 point improvement ( P < 0.001). Conclusion We report significant and clinically meaningful improvements in both work disability and clinical outcomes after commencement of anti-TNF therapy in a real-world setting. Improvements in all outcomes among those commencing csDMARDs were slower and of a smaller magnitude.
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Affiliation(s)
- William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases.,Department of Pharmacy and Pharmacology
| | | | | | - Ayman Askari
- Department of Rheumatology, Robert Jones and Agnes Hunt Hospital, Shropshire
| | - Annie Cooper
- Department of Rheumatology, Queen Alexandra Hospital, Portsmouth
| | - Paul Creamer
- Department of Rheumatology, North Bristol NHS Foundation Trust, Bristol
| | - Gavin Clunie
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Philip S Helliwell
- Department of Rheumatology, NIHR Leeds Biomedical Research Unit, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds
| | - Jana James
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases
| | - Lesley Kay
- Department of Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | | | - Suzanne Lane
- Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich
| | - Jonathon Packham
- Department of Rheumatology, Haywood Rheumatology Centre, Stoke-on-Trentand
| | - Ragai Shaban
- Department of Rheumatology, Queen Alexandra Hospital, Portsmouth
| | | | - Lyn Williamson
- Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Neil McHugh
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases.,Department of Pharmacy and Pharmacology
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Meunier J, Fautrel B, Roquelaure Y, Claudepierre P. Work-related discussions between French rheumatologists and their rheumatoid arthritis patients. Occup Med (Lond) 2016; 66:454-9. [PMID: 27048296 DOI: 10.1093/occmed/kqw031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) causes significant impairment of physical function, and thus adversely affects patients' ability to work. AIMS To document how often work limitations are discussed by rheumatologists and RA patients during consultations. METHODS We conducted an observational study in a sample of French rheumatologists and in a parallel sample of patients recruited by pharmacists. We asked all rheumatologists in France practising in private practice or mixed practice (private practice and hospital) to participate in a telephone survey about their most recent consultation with an RA patient. Randomly selected pharmacists recruited RA patients to complete a questionnaire about their most recent consultation with their rheumatologist. We included patients aged 20-59, with a paid job or unemployed. We calculated the proportion of consultations including work-related discussions in both samples. RESULTS Of the 1737 rheumatologists contacted, 153 (9%) described consultations with eligible patients. Of the 1200 pharmacists contacted, 39 (3%) recruited 81 RA patients. The proportion of consultations including work-related discussions was 50% [95% confidence interval (CI) 42-58%] in the rheumatologist sample and 52% (95% CI 41-63%) in the patient sample. The most frequent subject of discussion (88%) was physical problems related to work in both samples. CONCLUSIONS This is the first study to document the proportion of consultations where rheumatologists and their RA patients discuss work. Both specialists and patients reported that work was discussed in one in every two consultations.
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Affiliation(s)
- J Meunier
- Mapi Patient-Centered Outcomes, 27 rue de la Villette, 69003 Lyon, France,
| | - B Fautrel
- Université Pierre et Marie Curie, GRC 08, Institut Pierre Louis d'Epidémiologie et Santé publique, AP-HP, Service de Rhumatologie, Groupe Hospitalier Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - Y Roquelaure
- Laboratoire d'Ergonomie et d'Epidémiologie en Santé au Travail (LEEST) - Unité associée à l'Institut de veille sanitaire UPRES EA 4336, Université d'Angers, Faculté de Médecine Service de Médecine E, Centre Hospitalier Universitaire, 4 rue Larrey, 49933 Angers Cedex, France
| | - P Claudepierre
- Groupe Henri-Mondor Albert Chenevier, Service de Rhumatologie, AP-HP, Creteil 94010, France, Université Paris Est Créteil, LIC EA4393, Creteil 94010, France
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Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism. Best Pract Res Clin Rheumatol 2015; 29:495-511. [DOI: 10.1016/j.berh.2015.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Verstappen SM. Outcomes of early rheumatoid arthritis – The WHO ICF framework. Best Pract Res Clin Rheumatol 2013; 27:555-70. [DOI: 10.1016/j.berh.2013.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 09/20/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
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Almoallim H, Kamil A. Rheumatoid arthritis: should we shift the focus from “Treat to Target” to “Treat to Work?”. Clin Rheumatol 2013; 32:285-7. [DOI: 10.1007/s10067-012-2160-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 11/30/2022]
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Short P, Jones AC, Walker D, Kavanaugh A, Moots RJ. Working at arthritis. Rheumatology (Oxford) 2011; 51:201-3. [DOI: 10.1093/rheumatology/ker415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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