AB0142 SOCIOECONOMIC STATUS (SES) AND MEDICATION USE IN RHEUMATOID ARTHRITIS (RA): A SCOPING REVIEW
Authors: O. Russell, S. Lester, R. Black, C. Hill
Journal: Annals of the Rheumatic Diseases (2021)

Background: Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain. Objectives: To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain. Methods: MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable. SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables. Results: 1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA. Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded. Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded. 96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.) Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates. 70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies. Conclusion: Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use. References: [1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73. [2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9. [3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2. [4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64. Acknowledgements: This research was supported by an Australian Government Research Training Program Scholarship. Disclosure of Interests: None declared