Background Rheumatic and musculoskeletal diseases (RMDs) are prevalent and have a strong impact on health care costs. Some evidence in specific diseases indicates that patients with lower socio-economic background are at higher risk to have the disease and incur more healthcare costs. However, knowledge whether these effects of socio-economic status are comparable across all RMDs is lacking.
Objectives To compare the impact of socio-economic deprivation on occurrence of different RMDs and associated health care costs.
Methods An administrative dataset linking clinical (based on ICD codes), socio-demographics (age, gender and deprivation index) and health care utilization costs information of the entire adult (≥18 y.o.) population of the Basque Country, Spain was used. Deprivation index was based on area employment and education status, and included five categories (1 to 5 (most deprived)). Costs included primary and specialist care, planned and acute hospital admissions, and ambulatory drug prescriptions. Thirty-six individual diseases were grouped into seven larger diagnostic groups: Rheumatoid Arthritis, Crystal Arthropathies, Osteoarthritis, Soft tissue diseases, Connective Tissue Diseases, and Vasculitis. Logistic and Poisson regression models were computed to explore the relation between the deprivation index and the occurrence of the disease (separately and grouped) and health care utilization costs, respectively. Models were adjusted for age, gender, and models with costs were also adjusted for comorbities, computed with the Rheumatic Diseases Comorbidity Index.
Results In total, data from 1,923,156 individuals were analyzed. Mean age was 49.9 (SD18.4) years, 49% were males. Soft tissue diseases were the most prevalent (5.5%), third most costly in terms of health care utilization costs after vasculitis and rheumatoid arthritis. Socio-economic deprivation was associated with higher likelihood to have any of the RMDs, and gradients were of comparable magnitude. The strongest socio-economic gradient was seen for the occurrence of soft tissue diseases (OR 1.82 [95%CI 1.78;1.85], most vs. least deprived) (Figure). Deprivation was also associated with higher costs across the majority of the conditions, but a somewhat different pattern across diseases was seen. The strongest gradients were observed in patients with Spondyloarthritis (in particular. with Ankylosing spondylitis) and Vasculitis.
Conclusions Socio-economic deprivation was consistently associated with higher occurrence and higher costs across most of the RMDs. Among major RMDs, the group of soft tissue diseases (comprising chronic low back and neck pain, fibromyalgia, and soft tissue disease), was the most prevalent and costly for the society, and occurred more often in individuals with lower socio-economic status.
Disclosure of Interest None declared