Background Age, duration of disease, and gender are included in all clinical research reports as potential modifiers of patient status and treatment responses. Formal education level (EDUC), which has been interpreted as a surrogate for self-management and other patient actions and attitudes affecting health associated with socioeconomic status, is included in some, but not most reports. However, many reports indicate that a marker of socioeconomic status is more significant than age, disease duration, gender, or any known biomarkers to explain variation in patient status and outcomes, including mortality.
Objectives To analyze age, duration of disease, gender and EDUC to explain variation in patient global estimate of status (PATGL) in 1939 patients with all rheumatic diseases seen in usual care, and subgroups with RA, osteoarthritis (OA), systemic lupus erythematosus (SLE), gout and other diagnoses.
Methods All patients seen at one rheumatology site complete a multidimensional heath assessment questionnaire (MDHAQ) at all visits, which includes physical function in 10 activities; visual analog scales (VAS) for pain, PATGL and fatigue; and demographic data for age, formal education level and gender. Duration of disease is entered by the rheumatologist. Data are recorded in a longitudinal database and analyzed using STATA v11. The last available visit of each patient with complete data for all variables was studied in 6 multivariate regressions to analyze age, disease duration, gender and formal education level as independent variables to explain variation in PATGL, as the dependent variable, in all patients, and subgroups with RA, OA, SLE, gout and other diagnoses.
Results Among 1939 patients with complete data, 305 had RA, 250 OA, 220 SLE, 78 gout and 1086 other diagnoses. All 4 variables – age, gender, disease duration and EDUC – were limited to explain variation in PATGL, in contrast to robust explanation by pain and fatigue. Nonetheless, highest levels of significance in all analyses were seen for EDUC vs age, disease duration or gender. EDUC was the only significant variable in subgroups of patients with RA, OA, SLE and gout (Table).
Conclusions Formal education level is more explanatory of variation in PATGL than age, disease duration or gender. Reports of all clinical research studies should include a measure of socioeconomic status.
Disclosure of Interest None Declared
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