Formal education as a marker for increased mortality and morbidity in rheumatoid arthritis

doi:10.1016/0021-9681(85)90095-5

Journal of Chronic Diseases

Volume 38, Issue 12, 1985, Pages 973-984

Journal of Chronic D...

https://doi.org/10.1016/0021-9681(85)90095-5 Get rights and content

Abstract

Increased mortality and morbidity was seen in association with lower formal educational levels in 75 rheumatoid arthritis (RA) patients over 9 years. Nine of the 20 patients with 8 or fewer years of eduction had died, compared to 10 of 34 with 9–12 years of education, and only one of 21 with more than 12 years of education. Among survivors with functional capacity data available from baseline and 9 year review, declines greater than 20% were seen in 8 of 10, 13 of 21, and 9 of 19 patients in the three education categories. Overall, 79% of grade-school educated, 43% of high-school educated, and 20% of college-educated patients had either died or declined more than 50% in functional capacity. Patients of different formal educational levels were similar at baseline in age, duration of disease, measures of functional capacity, number of involved hand joints, number of severe radiographic changes, use of gold, oral corticosteroids or other therapies, and associations between formal educational level and disease course are not explained by these variables. Formal educational level appears a simple quantitative marker which identifies a surrogate or composite variable associated with increased mortality and morbidity in RA.

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Cited by (181)

A randomized controlled trial evaluating the effects of social networking on chronic disease management in rheumatoid arthritis
2022, Seminars in Arthritis and Rheumatism
Citation Excerpt :
Control group. With input from peer leaders, we created an educational website only for the purpose of the study (no longer functioning) accessible to those in the intervention and control groups including: [1] a learning center with information on RA characteristics, therapeutic options with benefits and harms, general healthcare needs, lifestyle issues, talking points for patients to discuss with their physicians and healthcare providers, and resources for psychosocial issues such as depression; [2] links to other evidence-based educational RA websites; [3] newsfeed from rheumatology organizations/societies; and [4] chronic disease management strategies. The website also included a downloadable PDF file on the website detailed 4 major components for chronic disease management: [1] goal setting and action and contingency planning; [2] coping skills, with instruction on relaxation techniques and stress management and addressing self-image issues; [3] reinforcement of healthy lifestyle and behaviors, including adherence to medical recommendations; and [4] communication skills to improve interactions with healthcare providers, caregivers, and peers.
Social networking has been shown to improve health outcomes in certain patient populations. While patients with rheumatoid arthritis (RA) increasingly use social networking to communicate with peers, the effects of these interactions are largely unknown.
In a randomized controlled trial, we compared RA patients who participated in a social networking group moderated by peer leaders and who had access to a static website offering RA materials with a control group, who only had access to the website. The primary outcomes were patients’ RA knowledge, self-efficacy and empowerment. Secondary outcomes included participation in desired health behaviors, and satisfaction with peer support, among others. Follow-up assessments were conducted at 3 and 6 months. Participants who never signed in were excluded from the primary analysis.
105 participants were randomized to each group. Mean age was 52 (±12.4) and 92.4% were females. Knowledge scores improved in both groups, but only in the control group the differences observed at 3 and 6 months were significant (p≤0.02). Self-efficacy scores also improved in both groups, but only the differences observed at 6 months in the Facebook group were significant (p=0.02). When comparing groups, at 3 months the knowledge improvements observed in the control group were greater compared with those observed in the Facebook group (mean difference 0.4 versus 0.1; respectively, p=0.03). No other differences were observed in secondary outcomes between the 2 groups, except in peer support satisfaction. The Facebook® group reported greater peer support satisfaction in 3 out 5 subscales compared with the control group (p≤0.04).
Peer support satisfaction was higher in participants using an online social network, but this was not translated into greater disease knowledge or empowerment.
Incidence, sociodemographic factors and treatment penetration of rheumatoid arthritis and psoriatic arthritis in Norway
2021, Seminars in Arthritis and Rheumatism
To evaluate nationwide incidence, sociodemographic associations and treatment penetration of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in Norway.
The study combined data from nationwide registries on the total Norwegian adult population (age ≥ 18). From the Norwegian Patient Registry, incident RA and PsA cases during 2011–2015 were identified with records of first and second healthcare episodes listing RA/PsA diagnostic codes, and ≥ 1 episode in an internal medicine or rheumatology unit with RA/PsA code during the two-year period after the first episode. Dispensed DMARD prescriptions were obtained from the Norwegian Prescription Database. Persons with dispensed DMARD prescriptions or biologic DMARDs given in hospitals > 12 months before the index date were excluded.
Incidence of RA/PsA in Norway was 42/26 per 100,000 person-years (55/28 among women and 28/23 among men). RA peak incidence was observed at ages 70–79 in both sexes, whereas the peak incidence of PsA occurred at ages 50–59. Age- and sex-standardized incidences of RA and PsA were lower among persons with higher education levels. Within a year from the index date, 82.4/57.4% of RA/PsA patients used synthetic DMARDs while 9.4/9.5% used biologic DMARDs.
Register-based incidence estimates for RA and PsA in Norway are similar to other Nordic countries, but slightly higher than in previous Norwegian studies. Furthermore, we found that higher socioeconomic status was associated with lower incidence of both RA and PsA. Although conventional synthetic DMARDs were less often used in early PsA than RA, frequency of biologic DMARD prescriptions was comparable.
Effect of education on disease activity and functional status in rheumatoid arthritis patients
2021, Egyptian Rheumatologist
To study the effect of education on rheumatoid disease in a cohort of Egyptian patients.
This study included 1022 consecutive rheumatoid arthritis (RA) patients recruited from several rheumatology clinics of public and private sectors from Cairo, Kafr Elsheik and Fayoum governorates. Their mean age was 45.1 ± 12.4 years and mean disease duration was 85.9 ± 73 months. Patients were divided into groups according to their educational level (university degree/high school/illiterate) and were compared regarding their disease activity score (DAS28) and modified health assessment questionnaire (mHAQ) as a measure of the functional status.
The mean age of patients was 45.1 ± 12.4 years, they were 854 females and 168 males and disease duration of 85.9 ± 73 months. 106 (10.4%) were smokers and 333 (32.6%) were employed. 342 (33.5%) were illiterate, 455 (44.5%) were non-university-educated and 225 (22%) university educated. Educated patients showed significant lower disease activity (p = 0.001), swollen joint count (p = 0.044), tender joint count (p = 0.001), doctors global assessment (p = 0.001), erythrocyte sedimentation rate (p = 0.003) and visual analogue scale (p = 0.001). Educated patients had significantly received more biologic therapy (p = 0.001) and attended regular follow-up (p = 0.001). They showed better functional status with significantly lower MHAQ and had significant higher percentage of employment (p = 0.001). Rheumatoid patients with a university degree had significantly lower diseases activity and better functional indices compared to those without. Further regression analysis showed that university education is a predictor for low disease activity.
Rheumatoid disease is influenced by education among Egyptians. Higher educated patients had lower disease activity and better functional outcome, and university education predicts low disease activity among Egyptian RA patients.
Equivalence in the Health Assessment Questionnaire (HAQ) across socio-demographic determinants: Analyses within QUEST-RA
2018, Seminars in Arthritis and Rheumatism
Citation Excerpt :
HAQ-II consists of 10 items and is now among the most frequently used HAQ versions [13]. There is increasing awareness that socio-demographic (SD) factors can have an important impact on RA outcomes [14–19]. The magnitude of health disparities related to SD background of patients has been the focus of public policy interest as some of them might be avoidable [20].
To investigate potential bias in scores of the Health Assessment Questionnaire (HAQ) related to socio-demographic (SD) background of patients with rheumatoid arthritis (RA).
Data from the Quantitative Standard Monitoring of Rheumatoid Arthritis study (QUEST-RA), comprising 9022 patients were analysed. Physical function was assessed through 30 items of four HAQ versions: the HAQ-Disability scale, HAQ-II, modified HAQ and multi-dimensional HAQ (MD-HAQ). DIF was investigated using item response theory models implemented in a latent variable modelling framework. Models were equivalent to ordinal logistic regression models with HAQ score (item level) as outcome, the latent trait ‘physical function’ and individual SD factors (age, gender, education, and employment status) as predictors. Next, scores of composite HAQs were adjusted for DIF. To assess the impact of DIF on associations between SD factors and HAQs, multilevel mixed-effect linear regression models with individuals nested in country were estimated with DIF-adjusted or unadjusted HAQ as outcome.
Relevant DIF (OR > 1.1 or <0.90) was found in several HAQ items primarily for age, gender and work status. Adjustment of composite HAQs for DIF resulted in small increases (Δ0.02–0.07); MD-HAQ best compensated for bias related to SD factors (Δ0.02). In regressions, all SD factors remained significantly related to DIF-adjusted HAQs, with differences in coefficients largest for gender (Δ0.02–0.07) but overall negligible.
SD factors produce response bias in individual HAQ items but have little impact on composite HAQs. When interpreting HAQ across SD factors, MD-HAQ is preferred, but caution remains when comparing function across gender.
Impact of educational level on rheumatoid arthritis: A systematic review
2014, Revista Colombiana de Reumatologia
Citation Excerpt :
It appeared that 75 studies did not meet the inclusion criteria as described. Finally, 68 studies2–8,11–69 which did meet the inclusion criteria were included in the systematic review. These included 17 cohorts, 8 case–controls, and 43 cross-sectional (Fig. 1).
To assess the impact of educational level on rheumatoid arthritis through a systematic review of the literature and assessing the age at onset, the educational level as risk factor, and to identify outcomes related to educational level and rheumatoid arthritis.
A systematic review was performed using PubMed, SciELO and LILACS as data bases in order to identify original articles written in English, Portuguese or Spanish that used accepted classification criteria for rheumatoid arthritis and a comparison was made between educational level and outcomes of rheumatoid arthritis. Final articles were identified by two independent reviewers and three blinded reviewers created a new list and extracted data from selected studies. Each record was classified based on the quality score of the studies.
Through the systematic review of the literature, the factors and outcomes related to educational level and rheumatoid arthritis identified were: the risk of developing the disease, radiographic progression, depression and anxiety, work disability, functional disability, quality of life, and mortality.
The information available in the literature about the impact of the educational level in several outcomes related to rheumatoid arthritisis variable. Only work disability is an outcome related to a low education level in all the articles reviewed.
Evaluar el impacto del nivel educativo sobre la artritis reumatoide a través de una revisión sistemática de la literatura analizando la edad de inicio, el nivel educativo como factor de riesgo e identificando los desenlaces relacionados con el nivel educativo y la artritis reumatoide.
Se realizó una revisión sistemática en PubMed, SciELO y LILACS como bases de datos con el fin de identificar artículos originales en inglés, portugués o español, que utilizaban criterios de clasificación aceptados para artritis reumatoide y comparaban el nivel educativo con diferentes desenlaces de la enfermedad. Los artículos finales fueron identificados por 2 revisores independientes. Tres revisores ciegos crearon una lista y extrajeron los datos de los estudios seleccionados. Cada registro fue clasificado en función de la calidad de los estudios.
Los factores y desenlaces identificados relacionados con el nivel educativo y artritis reumatoide fueron el riesgo de desarrollar la enfermedad, la progresión radiográfica, depresión y ansiedad, incapacidad laboral, incapacidad funcional, calidad de vida y mortalidad.
La información disponible en la literatura sobre el impacto del nivel educativo en la artritis reumatoide en los diferentes desenlaces encontrados es variable. Solo la discapacidad funcional es un desenlace relacionado con bajo nivel educativo en todos los artículos encontrados.
Rheumatoid Arthritis
2013, Women and Health

View all citing articles on Scopus

: These studies were supported in part by Multipurpose Arthritis Center Grant AM 22071, the Maury County Lupus Fund and the Jack C. Massey Foundation.

: These studies were presented in part at the Annual Meeting of the American Rheumatism Association, Minneapolis, Minn., June, 1984.

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Formal education as a marker for increased mortality and morbidity in rheumatoid arthritis

Abstract

J Chron Dis

Rheumatoid arthritis: the clinical spectrum

Clinical Picture of Rheumatoid Arthritis

Severe functional declines, work disability, and increased mortality in 75 rheumatoid arthritis patients studied over nine years

Arth Rheum

Length of life and cause of death in rheumatoid arthritis

N Engl J Med

The prognosis of rheumatoid arthritis

Course and prognosis of rheumatoid arthritis: a further report

Ann Rheum Dis

Survivorship and death in rheumatoid arthritis

Arth Rheum

Mortality in rheumatoid arthritics

Br J Prev Soc Med

Death rate and causes of death in RA patients during a period of five years

Scand J Rheum

Increased mortality among persons with rheumatoid arthritis, but where RA does not appear on death certificate

J Rheum

Cause and age at death in a prospective study of 100 patients with rheumatoid arthritis

Ann Rheum Dis

Rheumatoid arthritis and mortality

Arth Rheum

Survival and cause of death in rheumatoid arthritis

J Rheum

Survival and death in rheumatoid arthritis, editorial

J Rheum

Differential Mortality in the U.S.

A critical examination of the relationship between socioeconomic status and mortality

Am J Publ Health

Some Economic Aspects of Mortality in the United States

Occupation, education, and coronary heart disease

Science

The production of health: an exploratory study

Essays in the Economics of Health and Medical Care

J Human Resources

The correlation between health and schooling