SAT0395 SOCIAL ISOLATION IS INDEPENDENTLY ASSOCIATED WITH MORE SEVERE DISEASE IN AXIAL SPONDYLOARTHRITIS
Authors: S. S. Zhao, N. L. Harrison, L. Peruffo, N. Goodson
Journal: Annals of the Rheumatic Diseases (2020)

Background: Social isolation has negative impacts on health and wellbeing at different stages of life. It is associated with longer sickness absence and increased mortality in the general population [1]. Reducing social isolation is a growing governmental priority in many countries such as the UK. The effects of social isolation on patients with rheumatic diseases have not been studied. Objectives: To examine whether living alone impacts disease severity and quality of life among axial spondyloarthritis (axSpA) patients. Methods: We conducted a single-centre cross-sectional study of consecutive patients meeting the ASAS axial SpA criteria in Liverpool, UK. Patients answered questionnaires including whether they lived alone, which we used as a proxy for social isolation. Disease assessment measures included BASDAI, spinal pain, BASFI, quality of life (EuroQol), global health and fatigue. We separately extracted self-reported anxiety or depression from the EuroQol questionnaire (as absent, moderate, severe) since it is an important associated factor. Patient characteristics were compared between patients who lived alone and those who did not, using descriptive statistics. The association between social isolation and each disease measure were assessed using multivariable linear models, adjusted for age, gender, post-code derived deprivation index, BMI, anxiety/depression and smoking status. Results: A total of 353 patients (68% male, mean age 46 years) were studied; 82% met the modified New York criteria for ankylosing spondylitis. 58 (16%) patients reported living alone. These patients were older (49 vs 43 years, P=0.006), more frequently male (83 vs 65%, P=0.008), and more frequently current smokers (53 vs 31%, p=0.009). They were otherwise similar in the proportion meeting criteria for AS, HLA-B27 positivity, and BMI (Table 1). Self-reported anxiety or depression was not significantly different between the two groups. Regression models showed that patients living alone had 1 unit higher BASDAI, pain and BASFI than those who did not, independent of potential confounders (Table 2). Living alone was also associated with poorer quality of life, but not fatigue or global health. Table 1. Patient characteristics compared according to whether they live alone. Do not live alone Live alone P value N (%) 295 (83.6%) 58 (16.4%) Mean age, years (SD) 43.4 (14.0) 49.0 (12.4) 0.006 Males, n (%) 192 (65.1%) 48 (82.8%) 0.008 Meeting mNY criteria 238 (80.7%) 48 (82.8%) 0.712 HLA-B27 positive 109 (54.0%) 25 (71.4%) 0.054 Mean BMI, (SD) 28.17 (5.6) 29.40 (6.8) 0.196 Smoking status Current 87 (31.4%) 30 (52.6%) 0.009 Ex 52 (18.8%) 8 (14.0%) Never 138 (49.8%) 19 (33.3%) Self-reported anxiety or depression Absent 145 (49.2%) 22 (38.0%) 0.229 Moderate 120 (40.7%) 27 (46.6%) Extreme 30 (10.2%) 9 (15.5%) Deprivation Index, median (IQR) 2 (1, 5) 2 (1, 4) 0.190 Table 2. Impact of social isolation (living alone) on disease severity measures in axial spondyloarthritis. BASDAI 1.0 (0.2 to 1.8) Spinal pain 1.0 (0.03 to 1.9) BASFI 1.0 (0.1 to 1.9) Quality of life -0.13 (-0.24 to -0.02) Fatigue 0.1 (-0.7 to 0.9) Global health -0.03 (-0.8 to 0.7) Data shown as coefficient (95%CI). Quality of life assessed using EuroQol. All other indices are on a scale of 0 (best) to 10 (worst). Conclusion: Living alone - as a proxy for social isolation - was associated with more severe disease and poorer quality of life in axSpA patients, independent of depression and other confounders. Further studies are needed to examine the direction of causation, and whether lack of social support influences their ability to seek and/or benefit from healthcare provision. References: [1]Cornwell EY, Waite LJ. Social disconnectedness, perceived isolation, and health among older adults. J Health Soc Behav. 2009;50(1):31–48. Disclosure of Interests: None declared