Putrik Polina, Ramiro Sofia, Lie Elisabeth, Keszei Andras P, Kvien Tore K, van der Heijde Désirée, Landewé Robert, Uhlig Till, Boonen Annelies
Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University Health Promotion and Education, Maastricht University, Maastricht
Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
Rheumatology (Oxford). 2016 Jul;55(7):1217-24. doi: 10.1093/rheumatology/kew048. Epub 2016 Mar 24.
To explore whether age, gender or education influence the time until initiation of the first bDMARD in patients with RA.
Data from the Norwegian Register of DMARDs collected between 2000 and 2012 were used. Only DMARD-naïve patients with RA starting their first conventional synthetic DMARD were included in the analyses. The start of the first bDMARD was the main outcome of interest. Cox regression analyses were used to explore the impact of education, age and gender on the start of a first bDMARD, adjusting for confounders, either at baseline or varying over time (time-varying model).
Of 1946 eligible patients [mean (s.d.) age: 55 (14) years, 68% females], 368 (19%) received a bDMARD during follow-up (mean 2.6 years). In the baseline prediction model, older age [Hazard Ratio (HR) 0.97, 95% CI: 0.96, 0.98], lower education [HR = 0.76 and 0.68 for low and intermediate education levels vs college/university education, respectively (P = 0.01)] and female gender [only in the period 2000-03, HR = 0.61 (95% CI: 0.41, 0.91)] were associated with a lower hazard ratio to start a bDMARD. The time-varying model provided overall consistent results, but the effect of education was only relevant for older patients (>57 years) and became more pronounced by the end of the decade.
Less educated and older patients have disadvantages with regard to access to costly treatments, even in a country with highly developed welfare like Norway. Females had lower access in the beginning of the 2000s, but access had improved by the end of the decade.
探讨年龄、性别或教育程度是否会影响类风湿关节炎（RA）患者开始使用第一种生物改善病情抗风湿药（bDMARD）的时间。
使用了2000年至2012年间从挪威DMARD登记处收集的数据。分析仅纳入了开始使用第一种传统合成DMARD的初治RA患者。开始使用第一种bDMARD是主要关注的结局。采用Cox回归分析来探讨教育程度、年龄和性别对开始使用第一种bDMARD的影响，并对混杂因素进行校正，校正因素在基线时或随时间变化（时变模型）。
在1946例符合条件的患者中（平均年龄[标准差]：55[14]岁，68%为女性），368例（19%）在随访期间（平均2.6年）接受了bDMARD治疗。在基线预测模型中，年龄较大[风险比（HR）0.97，95%置信区间：0.96，0.98]、教育程度较低[低教育水平和中等教育水平与大专/大学教育水平相比，HR分别为0.76和0.68（P = 0.01）]以及女性[仅在2000 - 2003年期间，HR = 0.61（95%置信区间：0.41，0.91）]与开始使用bDMARD的风险比降低相关。时变模型提供了总体一致的结果，但教育程度的影响仅在年龄较大的患者（>57岁）中相关，并且在该十年结束时变得更加明显。
即使在像挪威这样福利高度发达的国家，教育程度较低和年龄较大的患者在获得昂贵治疗方面也处于劣势。在21世纪初，女性获得治疗的机会较低，但到该十年结束时有所改善。
