Abstract
Objectives: Use of biologics or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) is associated with infection in patients with rheumatoid arthritis (RA). Socioeconomic status is substantial in infectious diseases; however, the impact of socioeconomic status on risk for infection in patients with RA receiving b/tsDMARD remains unclear.Methods: We used the 2003–2017 Taiwanese National Health Insurance Research Database to identify patients with RA receiving b/tsDMARDs. A Cox regression analysis was used to estimate the associations of covariates with the risk of hospitalised infection shown as hazard ratios (HRs) with 95% confidence interval (CIs).Results: We identified 7,647 RA patients who started their first bDMARD/tsDMARD treatment. Log-rank analyses demonstrated the association between age (p < 0.001), urbanisation (p = 0.001), the insured amount (p = 0.021), and the hospitalisation. Cox proportional regression analyses showed that age was independently associated with hospitalised infection in a dose–response manner, whereas a high-income category had an inverse association (HR 0.48, 95% CI 0.23–0.96). Hospitalisation for infection within 5 years was a strong risk factor (HR 5.63, 95% CI 1.91–16.62), and living in a rural area tended to be a risk factor (HR 1.76, 95% CI 0.98–3.14) for incident hospitalised infection.Conclusions: This study showed the crucial impacts of age, socioeconomic status, and history of infection on hospitalised infection in patients with RA receiving b/tsDMARDs. These findings highlight the largely ignored role of socioeconomic status in risk stratification among patients receiving b/tsDMARDs for RA.
Highlights
Rheumatoid arthritis (RA) affects 0.5–1% of the global population and ranks as the 42nd highest contributor to the global disability with an enormous economic impact due to devastating arthritis and disability [1,2,3]
Accumulating evidence has shown the essential impact of socioeconomic status on the risk for infection in general populations [12, 13], but few studies have addressed the impact of socioeconomic status on risk for infection in patients with RA receiving b/targeted synthetic DMARD (tsDMARD) [10]
We found that hospitalisations within 5 years (HR 5.63, 95% confidence intervals (CIs) 1.91–16.62) were a robust predictor for incident hospitalised infection after the initiation of b/tsDMARDs in patients with RA
Summary
Rheumatoid arthritis (RA) affects 0.5–1% of the global population and ranks as the 42nd highest contributor to the global disability with an enormous economic impact due to devastating arthritis and disability [1,2,3]. The efficacy of b/tsDMARDs in the management of RA is well-established; an increased risk for infection remains a major concern [6,7,8,9,10,11]. Accumulating evidence has shown the essential impact of socioeconomic status on the risk for infection in general populations [12, 13], but few studies have addressed the impact of socioeconomic status on risk for infection in patients with RA receiving b/tsDMARDs [10]. In the present populationbased study in Taiwan, we enrolled biologics-naïve patients with RA and received b/tsDMARDs between 2003 and 2017 to address risk factors, including income and urbanisation level, for infection requiring hospitalisation
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
