Effect of social deprivation on disease severity and outcome in patients with rheumatoid arthritis

Objective—Social deprivation is now recognised to have an important impact on morbidity and mortality. This study sought to ascertain the eVect of deprivation, if any, on disease severity, functional disability, and outcome in rheumatoid patients in Glasgow. Methods—814 patients with rheumatoid arthritis (RA) were assessed for clinical, functional, and laboratory indices of disease activity. Deprivation categories for individual patients were determined using the Carstairs index. Five year follow up is available for 440 patients. Results—The study population of RA patients live largely in the most deprived areas. Patients from deprived areas have significantly poorer function at outset and at five years as defined by the Health Assessment Questionnaire (HAQ) score. This is not attributable to diVerences in disease duration in patients from the most deprived regions or compliance with treatment. Furthermore, these patients do not achieve over five years the initial functional level of those living in the most advantaged localities. Conclusion—RA patients from deprived areas have poorer function, which is associated with greater need—medical, social, and paramedical. Strategies and resources for healthcare need to be adjusted according to this variation. (Ann Rheum Dis 1997;56:410‐413) The eVect of socioeconomic disadvantage on mortality patterns is well documented and has important implications for health care strategies. 12 The eVect of deprivation on the course and outcome of a chronic disease such as rheumatoid arthritis (RA) may also be important and may influence patient welfare over many years or indeed decades. Formal education may be regarded as a surrogate marker of socioeconomic status although there are many confounding factors. Pincus et al have shown that outcome of RA in terms of laboratory and functional measurements of disease activity is inversely related to the number of years of formal education in the USA. 3