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FRI0584 The Vicious Circle of Educational Level, Rheumatoid Arthritis, and Risk of Poverty - Results of A Cross-Sectional Multicenter Study in Germany
  1. M. Zänker1,2,3,
  2. U. Schwill1,
  3. C. Bielecke1,2,
  4. A. Jacobi2,3,4,
  5. K. Sokoll2,4,
  6. G. Zeidler5,
  7. A. Scheibert5,
  8. P. Reutermann2,6,
  9. M. Bohl-Bühler7,
  10. J.M. Engel8,
  11. U. Prothmann9,
  12. M. Backhaus10
  1. 1Immanuel Klinikum Bernau Heart Center Brandenburg, Bernau
  2. 2Rheumatic Disease Center, Northern Brandenburg
  3. 3Brandenburg Medical School
  4. 4Ruppiner Kliniken, Neuruppin
  5. 5Johanniter-Krankenhaus, Treuenbrietzen
  6. 6KMG Elbtalkliniken, Bad Wilsnack
  7. 7Rheumahaus, Potsdam
  8. 8MVZ Epikur, Bad Liebenwerda
  9. 9Knappschaftkrankenhaus, Püttlingen
  10. 10Park-Klinik Weißensee, Berlin, Germany

Abstract

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

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