Background Formal education level as a marker of socioeconomic status has been found to be associated with clinical status in several cohorts of patients with rheumatoid arthritis (RA) studied in the United States (US). It appeared of interest to analyse a cohort of Finnish patients according to formal education level and compare the results to US patients.
Objectives To analyse 3 cohorts of patients with RA, including 928 patients from Central Finland (Cohort A; mean age 62 years, mean disease duration 11 years), 418 patients from southeastern US (Cohort B; mean age 56 years, mean disease duration 10 years), and 1414 patients from private practices in 8 US cities (Cohort C; mean age 56 years, mean disease duration 12 years).
Methods Patients in Cohort A completed a health assessment questionnaire (HAQ), and patients in Cohorth B and C completed its modified version (MHAQ) (range 0 – 3); all patients completed a visual analogue pain scale (VAS) (range 0 – 10) and indicated years of formal education. The cut points for high versus low formal education level were 9 years or more (478 patients – 52%) vs. <9 years (450 patients) for Finnish patients in Cohort A; 12 years or more (304 patients – 73%) vs. <12 years (114 patients) for US patients in Cohort B; and 12 or more years (1049 patients – 74%) vs. <12 years (365 patients) for US patients in Cohort C. Patients with fewer years of education were older (p < 0.001 in all 3 cohorts) and had longer duration of disease (p = 0.396 – p < 0.001). Therefore, all analyses according to education were adjusted for age and duration of disease.
Results In Cohort A, mean HAQ scores were 0.64 in patients with high education versus 0.99 in those with low education (p = 0.04 adjusted for age and duration of disease). In Cohort B, mean MHAQ scores were 0.67 in patients with high education versus 1.02 in those with low education (p < 0.001 adjusted for age and duration of disease). In Cohort C, mean MHAQ scores were 0.58 in patients with high education versus 0.78 in those with low education (p < 0.001 adjusted for age and duration of disease). Pain VAS scores were 2.7, 3.3, and 3.8 in the high education groups vs. 3.9, 5.0, and 4.9 in the low education groups of Cohorts A, B, and C, respectively 9 (all p < 0.001 adjusted for age and duration of disease).
Conclusion Differences in clinical status according to years of formal education appear similar in Finnish and US patients with RA, although at different education and pain score levels. Years of education may serve as a marker for self-management, and other variables endogenous to the patient, in contrast to variables affected primarily by health professionals, which may importantly affect the course and outcomes of RA and other chronic diseases.
Callahan LF, Pincus T. Formal education level as a significant marker of clinical status in rheumatoid arthritis. Arthritis Rheum. 1988;31:1346–57
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