Background Compared to the general population, patients with rheumatoid arthritis (RA) are threatened by poverty due to treatment-related expenses, disability, and early retirement. Also, lower socio-economic state is associated with increased prevalence and severity of RA. The underlying mechanisms are still unclear.
Objectives To evaluate the risk of poverty of RA-patients in an unselected community-based cohort in the German states of Brandenburg and Saarland, and to investigate interrelationship between educational level, socio-economic state and disease severity.
Methods Cross-sectional multicenter study consecutively recruiting RA-patients in outpatient-clinics in Brandenburg and Saarland. Inclusion criteria were written consent and diagnosis of RA fulfilling ACR/EULAR-criteria. Using anonymised questionnaires, equivalised disposable income (EDI = total net income of a household divided by the number of equalised household members) was calculated. Risk of poverty was defined as <60% of the median EDI in Germany. Additionally, treatment-related expenses and effects of RA on social life were evaluated.
Results Of all 910 returned questionnaires (return rate 88%), 882 (97%) were evaluable (666 from Brandenburg and 215 from Saarland). The mean±SD age of all patients was 61±12 years, 71% were female, mean functional capacity (FFbH) was 72±23%, rate of biologic treatment was 41%, and 21% were active smokers. Median monthly EDI of RA-patients was 1239€ (IQR 869–1654), 88% of the median EDI in Germany (1413€). The rate of RA-patients at risk of poverty was significantly higher compared to the population in Germany (27% vs. 16%, p<0.001). Of the RA-patients, 414 (52%) had approved disability and 136 (21%) got early retirement at a mean age of 55±11 years. Of all patients, 25% waved a drug prescription at some point due to financial reasons. The RA-subgroup at risk of poverty waived prescriptions even more often (37% vs. 18%, p<0.001), had a higher rate of active smokers (27% vs. 19%, p=0.009) with more pack-years (5.1±10.9 vs. 3.5±9.6, p=0.034), had worse functional scores (FFbH 64±25% vs. 75±22%, p<0.001) and higher rates of early retirement (30% vs. 17%, p<0.001) compared to the patients without poverty risk. Patients with an university degree had less functional impairment (mean FFbH 84±18% vs. 71±23%, p<0.001), lower early retirement rates (7% vs 22%, p=0.004) and older age at retirement (59±7 vs. 55±12years, p=0.023) than patients without a degree. These findings were not associated with different smoking rates, nutrition type, oral hygiene, exposure to agricultural or silica dust, or early diagnosis of RA.
Conclusions RA-patients in this study had an almost doubled risk of poverty compared to the general population. Poverty reduces compliance to treatment resulting in a vicious circle. Lower educational level is associated with more severe disease course of RA, but the underlying mechanisms need further elucidation.
Disclosure of Interest None declared