Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Lower Education as a Proxy for Socioeconomic Status Is?Not Associated with Poor Outcomes in Systemic Sclerosis (SSc): Data from a Large SSc Cohort (Canadian Scleroderma Research Group).
Mansour4, Samah, Bonner2, Ashley, Baron1, Murray, Pope3, Janet E.
In SLE, socioeconomic status (SES) has a large effect on outcomes such as renal failure. It is unknown what the effect of SES is on outcomes in SSc. SES is often measured by income and education. In SSc, in general, highest education would be attained often decades prior to disease onset whereas current income could be low due to SSc and thus would confound interpretation of effect of SES on SSc. SES can modify outcomes by altering timing of access to care, access to medications, and adherence. Lower SES may be a surrogate for other health related behaviors that can impact outcome.
The Canadian Scleroderma Research Group (CSRG) collects detailed data annually on more than 1000 SSc patients including income, education level, antibodies, organ involvement, medications and survival. For measuring SES we used education: did not complete high school (<HS) or completed high school (HS). We could not use income for SES as poor outcome would be associated with lower income if it caused work disability. Linear regressions were used to assess the education effect on disease outcome as measured by severity score, global physician scores and survival (time from onset of scleroderma till death). Logistic regressions were done to detect any effect of education on mortality, presence of Class III pulmonary artery hypertension (PAH), interstitial lung disease (ILD) [total lung capacity (TLC) less or more than 70%], renal failure (serum creatinine level less or more than 150 umol/L). Data were subdivided into limited and diffuse cutaneous SSc and by disease duration.
The study included 1145 patients. Eighty six percent of the patients were females (986 females) and 14 % were males (159 males). Their mean age was 55.4 years. About 27.6% of them did not complete high school while 72.4% completed high school. In table (1), linear regressions did not show any statistically significant association between education level and severity score, global physician severity score, global physician activity score, global physician damage score and survival (p = 0.94, 0.63, 0.89, 0.78, and 0.60 respectively). Moreover in table (2), logistic regressions did not show any statistically significant association between education level and ILD, PAH, renal failure and mortality. The odds ratio and its confidence interval were 0.87 (0.45, 1.72), 1.09 (0.72, 1.66), 0.66 (0.32, 1.36) and 0.61 (0.37, 1.02) respectively. Education was not predictive of worse outcomes of scleroderma containing usual risk factors (Gender, age, ESR, Hb, ANA and SCL70).
Unlike SLE which has younger onset, in SSc education is not associated with worse outcomes when adjusting for usual risk factors.
To cite this abstract, please use the following information:
Mansour, Samah, Bonner, Ashley, Baron, Murray, Pope, Janet E.; Lower Education as a Proxy for Socioeconomic Status Is?Not Associated with Poor Outcomes in Systemic Sclerosis (SSc): Data from a Large SSc Cohort (Canadian Scleroderma Research Group). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1221