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Centre for Rheumatic
Diseases, Royal Infirmary , Castle Street, Glasgow G4 0SF
Correspondence to: Dr H A Capell.
Accepted for publication 22 April 1999
BACKGROUND
Socioeconomic
deprivation is associated with increased mortality from cardiovascular
causes and malignancy. The influence of disadvantage in patients with
rheumatoid arthritis (RA), who are known to have premature mortality,
has not been ascertained.
AIMTo assess the
relation between the level of patient deprivation and mortality in RA patients.
METHODS200 RA
patients, enrolled in a study comparing sulfasalazine and penicillamine
in 1984-85, have been followed up prospectively for 12 years. Subjects
were categorised into Carstairs groups with deprivation scores ranging
from 1 (most affluent) to 7 (most deprived). Information about deaths
was obtained from the Registrar General in Scotland, death certificates
and GP/hospital records.
RESULTSThere were
more RA patients in the deprived areas then expected compared with the
West of Scotland and England and Wales. Some 47.5% of the RA patients
had died by 12 yearsthe majority of cardiorespiratory causes or
malignancy. There were no differences in the median age or disease
duration in the various Carstairs groups at study entry, but the
percentage of deaths was higher in the more deprived groups after 12 years (36% dead in most affluent area compared with 61% in the most
deprived, that is, in groups 6 and 7).
CONCLUSIONIn patients
with RA increasing deprivation was associated with premature mortality.
If confirmed elsewhere these findings have implications for
rheumatological management strategies, for researchers involved in
collaborative studies of patients from different socioeconomic
backgrounds and for resource allocation.
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