P012 Health inequalities in the diagnosis and treatment of rheumatoid arthritis

Abstract

Abstract Background/Aims Patients with chronic diseases, such as rheumatoid arthritis (RA), from socially deprived backgrounds are known to have more severe disease, comorbidity and higher mortality rates. This study used National Early Inflammatory Arthritis Audit (NEIAA) data submitted by Lancashire and South Cumbria Foundation Trust to ascertain if social deprivation influences time to diagnosis and treatment escalation onto a high-cost drug (HCD). Methods Patients diagnosed with an inflammatory arthritis were recruited to NEIAA over a five-year period (May 2018 to March 2023). Information on demographics, patient postcodes, duration of symptoms prior to referral, GP referral time and rheumatology waiting time were analysed. Index of Multiple Deprivation (IMD) was derived from patient postcodes and patients divided into three groups based on IMD deciles. Patients with deciles 1-3 were grouped as most deprived, deciles 4-6 as middle and deciles 7-10 as least deprived. A case note review of a subgroup of patients who had been on treatment for 2-5 years was undertaken to investigate whether IMD decile was associated with treatment escalation onto a HCD. Data were analysed using descriptive and inferential statistics on Stata. Results were adjusted for confounders including age and gender. Results A total of 265 patients with RA were included, mean age 60 years, 63% female and 10% from ethnic minority groups. There were 31%, 25% and 44% in the most, middle and least deprived groups respectively. There was a higher proportion of patients from minority ethnic backgrounds in the most deprived group (most 21% vs least 3%). Symptom duration at time of presentation to the GP was greater than 3 months in 57% vs 48% of patients in the most and least deprived groups, respectively. Median was used to compare the GP referral times and rheumatology waiting times as there were outliers in the dataset. The most deprived group had longer GP referral times (most 16 days vs least 7 days); however, median rheumatology waiting time was similar across the three groups (most, middle and least deprived 27, 24 and 25 days respectively). There was no difference in escalation onto a HCD across the three groups. Conclusion Patients from the most deprived areas presented later and took longer to be referred. However, time to being seen in the rheumatology clinic and escalation onto a HCD was not found to be associated with social deprivation. Exploring this further on a national level will help understand if social deprivation is influencing care elsewhere. This work supports the need to focus more resource on raising public awareness in more deprived areas. Disclosure S. Jeyaratnam: None. S. Fish: None. S. Horton: None. A. Madan: None. C. Rao: None. E. MacPhie: None.