Background Compared to the general population patients with rheumatoid arthritis (RA) are endangered by poverty due to treatment-related expenses. Moreover they suffer from reduced functional capability and disability and are threatened by unemployment or early retirement. Additionally there is still unexplained evidence of increased prevalence of RA associated with higher mortality in individuals with lower educational level.
Objectives To determine the average income of RA-patients in an unselected community-based cohort in Northern Brandenburg, Germany, to identify disease-related factors associated with poverty, and to evaluate interrelationship between socioeconomic state and disease severity.
Methods Prospective cross-sectional study among 158 consecutively recruited RA-patients treated in our outpatient-clinic (Bernau) during 3 months. Inclusion criteria were written consent and diagnosis of RA, fulfilling ACR/EULAR-criteria. Using anonymized questionnaires data were obtained for calculating median equivalized disposable income (MEDI, i.e. total net income of a household divided by the number of its members converted into equivalized adults, using modified OECD equivalence scale). The at-risk-of-poverty-rate (RPR) was calculated using the 60% threshold (€794) of MEDI of the State Brandenburg according to official census report. Additionally, treatment-related expenses and effects of RA on social life were evaluated.
Results Of all 155 returned questionnaires (return rate 98%), 143 were evaluable. Patient mean age ± SD was 60.5±11.7 years, 64% female, 26% active smokers. Monthly median EDI of RA-patients was €1133 (IQR 835-1350), which is 86% of the MEDI in the region (€1323) and 80% of the MEDI in Germany (€1413). The at-risk-of-poverty-rate (RPR) was significantly higher compared to the population in Brandenburg (22% vs. 14% OR 1.83 p<0.001).Prescriptions were waived in 17% of patients at some point due to financial reasons. RA was disabling in 72 patients (50%) with mean commissioned degree of disability (DOD) 57±20%. RA influenced socioeconomic status as follows: 31% had to change their initial profession, 8% lost their job due to RA, 16% got early retirement at mean age of 54.9±10.5 years. Analyzing subgroups, RA-patients in the at-risk-of-poverty-group showed significantly worse mean DOD (68±22% vs. 52±18%, p=0.002), waived a prescription due to financial reasons more often (27% vs. 12%, p=0.031) and were retired at younger age (51.4±12.8 vs. 56.6±8.7 years, p=0.04) than other RA-patients. RA-patients with a university degree showed disease manifestations 10 years later (mean age 53.3±10.6 vs. 43.2±15.5 years, p=0.001), experienced less functional limitations (mean FFbH 79.0±26.4 vs. 66.8±27.1%, p=0.043) and were significantly less often early retired (9.7% vs 30.4%, p=0.021) than patients with lower educational level
Conclusions RA-patients have significantly lower income compared to the general population resulting in a doubled risk of poverty. Our data support the notion that poverty is not only result of disabling RA and its disease-related expenses but that poverty and educational level themselves may influence disease course of RA thus resulting in a vicious circle.
Disclosure of Interest None declared