Associations of Socioeconomic Status With Disease Progression in African Americans With Early Rheumatoid Arthritis

Abstract

In prior cross-sectional analyses of African Americans (AA) with RA, measures of socioeconomic status (SES) were associated with clinical joint damage and poorer patient-reported outcome (PRO) scores. The purpose of this study is to determine whether SES measures are associated with disease progression in a cohort of AA patients with early RA (<2 years duration). We analyzed baseline SES and change in 60-month clinical radiographs and PRO data (n=101 and 177, respectively) in individuals with early RA. SES measures were educational attainment, occupation, homeownership, household income, and block group poverty (BGP). Outcomes were based on radiographs (total erosion and joint space narrowing [JSN] scores on hands and feet) and PROs (pain, fatigue, disability, and learned helplessness). We used logistic regression with mixed effects accounting for study site to estimate odds ratios (OR) and 95% confidence intervals (CI). Both low education and occupation status were associated with worsening pain (aOR=5.86, 95% CI=3.05–11.3 and aOR=2.55, 95% CI=1.54–4.21). Patients without a high-school diploma were more likely to have worsened reports of learned helplessness (OR=1.92, 95% CI=1.37–2.67). Community measures of SES were also significantly associated with PRO score changes. Patients living in areas of BGP ≥20% were twice as likely to experience increased disability scores over 60 months of disease duration (OR=1.95, 95% CI=1.17–3.25). We found no association between SES measures and erosion or JSN score progression. Low educational attainment and non-professional occupation status were associated with increased worsening of PROs. However, there were no corresponding increases in radiographically assessed erosion or JSN score progression.