Australian study finds link between arthritis and poverty

By Jane Lewis 
An Australian study investigating the relationship between arthritis and poverty has found that developing arthritis significantly increases the risk of falling into poverty, especially in women, and described arthritis as ‘an overlooked driver of poverty rates.’

The study is the first to show a longitudinal association between the development of arthritis and the increased risk of falling into poverty, Dr Bethan Richards, Head of the Department of Rheum­atology at Sydney’s Royal Prince Alfred Hospital, told Medicine Today.

‘With estimates from the Australian Bureau of Statistics suggesting that around 15% of Australians suffer from arthritis, the potential economic implications of this association are substantial,’ she said.

The survival analysis of nationally representative, longitudinal survey data from adults aged 21 years or over found that between 2007 and 2012, almost a quarter (24%) of people who developed arthritis fell into income poverty, compared with 14% of those who did not develop arthritis (hazard ratio [HR], 1.51 for women; 1.22 for men). Being younger, married and a home­ owner all decreased the HR for falling into income poverty, whereas living in regional areas increased the ratio.

The analysis, published online in Arthritis & Rheumatism, also showed that people with arthritis were at a significantly higher risk of falling into ‘multidimensional poverty’ – that is, poverty measured by multiple aspects of peoples’ lives in addition to their income (HR, 1.87 for women; 1.29 for men). Those who developed arthritis between 2007 and 2009 were found to have a lower survival probability at each time point throughout the five­-year study period, compared with those who had never had arthritis.

The authors acknowledged the study’s limitations included that its findings were not able to differentiate between types of arthritis, and that there may be possible confounders not taken into account, such as comorbidities.

‘When managing patients with arthritis, GPs need to be mindful of the increased risk of falling into poverty, particularly in the few years following diagnosis,’ advised Dr Richards. ‘Knowing a significant proportion of such patients may have a reduced income over time, clinicians should sensitively enquire about any changes in financial status and take this into account when updating treatment plans that involve out­-of-­pocket costs.’

‘Given the escalating prev­alence and associated economic burden of arthritis, preventive strategies to address common risk factors such as obesity, and implementation of evidence­ based models of care are urgently required,’ she added.

Arthritis Rheum 2015; doi: 10.1002/art.39277.

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