Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Influence of Lifecourse Social Position on Rheumatoid Arthritis Disease Severity in African Americans.
Cleveland1, Rebecca J., Schwartz1, Todd A., Jonas1, Beth L., Alarcon2, Graciela S., Brasington3, Richard, Conn4, Doyt L., Smith5, Edwin A.
University of North Carolina, Chapel Hill, NC
University of Alabama at Birmingham, Birmingham, AL
Washington Univ School of Med, St. Louis, MO
Emory Univ School of Medicine, Atlanta, GA
Med Univ of South Carolina, Charleston, SC
University of Pittsburgh, Pittsburgh, PA
Marguerite Jones Harbert-Gene V. Ball, MD Professor of Medicine, and Director, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL
Current social position (SP), defined as individual level socioeconomic status, has been shown to be associated with poorer rheumatoid arthritis (RA) outcomes in whites, although it is less established in African Americans (AA). Associations between childhood SP and health have often been independent of adult SP, however this has not been evaluated for RA outcomes in whites or AA. We examined whether there are independent associations between SP over the lifecourse (current adult and childhood SP) with RA severity and patient reported outcomes (PROs).
We conducted a cross-sectional analysis of 371 AA individuals with RA who were part of a consortium of 5 medical centers in the southeastern US. Childhood SP was defined as the SP of their caregivers. Participants reported on their own and their childhood caregivers' SP, including educational attainment (<= high school [HS] diploma, or >HS), occupation (OCC) (professional or non), and homeownership (yes or no). Outcomes included joint severity (tenderness, swelling and malalignment); radiographs (erosion, JSN score); laboratory measures (C-reactive protein [CRP] levels, rheumatoid factor [RF] isotype IgM [RFIgM] or RFIgA, and anti-cyclic citrullinated protein antibodies [anti-CCP]); and PROs (HAQ, pain and fatigue visual analog scales [VAS], helplessness Rheumatology Attitudes Index [RAI], and counts of poor physical, poor mental, and limited activity days). Covariates included gender, age, RA disease duration, clinical comorbidity index, current Methotrexate/Leflunomide and biologic agent use. Adjusted bivariate analyses were performed to examine mean values of RA severity markers and PROs according to measures of adult and childhood SP. Adjusted regression models were conducted on all SP measures to determine associations with RA severity and PROs.
Participants' mean age was 56 years, RA duration was 137 months, and they generally had higher SP measures as adults than during childhood, where 53% of participants had >HS compared to only 16% of caregivers (P<0.001), and 49% had a professional OCC compared to 15% of caregivers (P<0.01). However, more participants' caregivers were homeowners than participants (57% vs. 46%, P<0.05). 11.9% had high lifecourse SP (both adult and childhood), 37.5% had current high/childhood low SP, 6.7% had childhood high/current low SP and 43.9% had low lifecourse SP. Mean fatigue VAS was significantly higher for participants' whose caregivers were non-homeowners or had <=HS, as was physically unhealthy days. In regression models mutually adjusting for adult and childhood SP, significant associations were observed for low childhood SP for fatigue VAS (b=-1.0; 95% CI=-1.9, -0.1); however low adult SP appeared to have stronger independent associations with most measures of radiographs, lab values, HAQ, RAI and pain VAS. When compared to subjects with high lifecourse SP, those with low adult SP generally had poorer RA outcomes, regardless of childhood SP.
Although low childhood SP was associated with poorer values for some RA outcomes, low current adult SP appears to be a stronger independent predictor for most RA disease severity measures and PROs.
To cite this abstract, please use the following information:
Cleveland, Rebecca J., Schwartz, Todd A., Jonas, Beth L., Alarcon, Graciela S., Brasington, Richard, Conn, Doyt L., et al; Influence of Lifecourse Social Position on Rheumatoid Arthritis Disease Severity in African Americans. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2642