Ann Rheum Dis 1999;58:525-529 ( September )

Extended report

Does social disadvantage contribute to the excess mortality in rheumatoid arthritis patients? N Maiden, H A Capell, R Madhok, R Hampson, E A Thomson

Centre for Rheumatic Diseases, Royal Infirmary , Castle Street, Glasgow G4 0SF

Correspondence to: Dr H A Capell.

Accepted for publication 22 April 1999

BACKGROUNDSocioeconomic deprivation is associated with increased mortality from cardiovascular causes and malignancy. The influence of disadvantage in patients with rheumatoid arthritis (RA), who are known to have premature mortality, has not been ascertained.
AIMTo assess the relation between the level of patient deprivation and mortality in RA patients.
METHODS200 RA patients, enrolled in a study comparing sulfasalazine and penicillamine in 1984-85, have been followed up prospectively for 12 years. Subjects were categorised into Carstairs groups with deprivation scores ranging from 1 (most affluent) to 7 (most deprived). Information about deaths was obtained from the Registrar General in Scotland, death certificates and GP/hospital records.
RESULTSThere were more RA patients in the deprived areas then expected compared with the West of Scotland and England and Wales. Some 47.5% of the RA patients had died by 12 yearsthe majority of cardiorespiratory causes or malignancy. There were no differences in the median age or disease duration in the various Carstairs groups at study entry, but the percentage of deaths was higher in the more deprived groups after 12 years (36% dead in most affluent area compared with 61% in the most deprived, that is, in groups 6 and 7).
CONCLUSIONIn patients with RA increasing deprivation was associated with premature mortality. If confirmed elsewhere these findings have implications for rheumatological management strategies, for researchers involved in collaborative studies of patients from different socioeconomic backgrounds and for resource allocation.

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© 1999 by Annals of the Rheumatic Diseases
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