Korean J Intern Med.
2024 Jul;39(4):668-679. 10.3904/kjim.2023.276.
Impact of socioeconomic status on biologics utilization in rheumatoid arthritis: revealing inequalities and healthcare efficiency
- Affiliations
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- 1Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 2Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, Korea
- 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 4Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 5Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 6Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- KMID: 2556916
- DOI: http://doi.org/10.3904/kjim.2023.276
Abstract
- Background/Aims
This cross-sectional study aimed to investigate biologics treatment disparities in rheumatoid arthritis (RA) patients based on socioeconomic status (SES).
Methods
Data from the KOrean Observational Study Network for Arthritis (KORONA) database were analyzed to assess various factors associated with SES, health behaviors, and biologics use. Logistic regression and structured equation modeling (SEM) were utilized for data analysis.
Results
Among 5,077 RA patients included, 393 (7.7%) patients were identified as biologics users. Within the entire cohort, 31.8% of the participants were in the low-income and low-education groups, and 39.3% of the participants were in the high-income and high-education groups. Despite the patients with low income or low education experienced higher disease activity at diagnosis, had more comorbidities, exhibited higher medication compliance, underwent more check-ups, and had more hospital admissions than their counterparts, the odds of patients with low-income receiving biologics were 34% lower (adjusted odds ratio = 0.76, 95% confidence interval: 0.60–0.96, p = 0.021) after adjustment for demographics and comorbidities. SEM and pathway analyses confirmed the negative impact of low SES on biologics use.
Conclusions
The findings suggest that SES plays a significant role in biologics use among RA patients, indicating potential healthcare inefficiencies for low SES patients. Moreover, adverse healthcare habits negatively affect biologics use in RA patients. The study highlights the importance of considering socioeconomic factors while discussing biologics use and promoting equitable access to biologics for optimal RA management.
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