RT Journal Article
T1 Individual-level and country-level socio-economic factors and health outcomes in spondyloarthritis: analysis of the ASAS-perSpA study
A1 Capelusnik, Dafne
A1 Zhao, Sizheng Steven
A1 Boonen, Annelies
A1 Ziade, Nelly
A1 Medina, Clementina Lopez
A1 Dougados, Maxime
A1 Nikiphorou, Elena
A1 Ramiro, Sofia
K1 spondyloarthritis
K1 psoriatic arthritis
K1 peripheral arthritis
K1 disease outcomes
K1 socio-economic factors
K1 Ankylosing-spondylitis
K1 Social determinants
K1 Disease-activity
K1 Generation health
K1 Fatigue
K1 Equity
K1 Marker
K1 Gap
AB Objectives The aim of this study was to investigate the association between individual-level and country-level socio-economic (SE) factors and health outcomes across SpA phenotypes. Methods Patients with axial SpA (axSpA), peripheral SpA (pSpA) or PsA from the ASAS-perSpA study (in 23 countries) were included. The effect of individual-level (age, gender, education and marital status) and country-level [e.g. Gross Domestic Product (GDP)] SE factors on health outcomes [Ankylosing Spondylitis Disease Activity Score (ASDAS) >= 2.1, ASDAS, BASFI, fatigue and the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI)] was assessed in mixed-effects models adjusted for potential confounders. Interactions between SE factors and disease phenotype were tested. A mediation analysis was conducted to explore whether the impact of country-level SE factors on ASDAS was mediated through biologic/targeted synthetic (b/ts) DMARD uptake. Results In total, 4185 patients (61% males, mean age 45) were included (65% axSpA, 25% PsA, 10% pSpA). Female gender [beta= 0.14 (95% CI: 0.06, 0.23)], lower educational level [beta = 0.35 (0.25, 0.45)) and single marital status [beta = 0.09 (0.01, 0.17)] were associated with higher ASDAS. Living in lower GDP countries was also associated with higher ASDAS [beta = 0.39 (0.16, 0.63)], and 7% of this association was mediated by b/tsDMARD uptake. Higher BASFI was similarly associated with female gender, lower education and living alone, without the effect of country-level SE factors. Female gender and lower educational level were associated with worse ASAS-HI, while more fatigue was associated with female gender and higher country-level SE factors [lower GDP, beta = -0.46 (-0.89 to -0.04)]. No differences across disease phenotypes were found. Conclusions Our study shows country-driven variations in health outcomes in SpA, independently influenced by individual-level and country-level SE factors and without differences across disease phenotypes.
PB Oxford univ press
SN 1462-0324
YR 2021
FD 2021-10-01
LK https://hdl.handle.net/10668/25828
UL https://hdl.handle.net/10668/25828
LA en
DS RISalud
RD Apr 5, 2025