Fuller Daniel T, Kedar Eyal, Lovelett Carly R, Mondal Sumona, Sur Shantanu
Department of Mathematics, Clarkson University, Potsdam, USA.
Clinical and Rural Health Research, St. Lawrence Health, Potsdam, USA.
Cureus. 2021 Nov 10;13(11):e19432. doi: 10.7759/cureus.19432. eCollection 2021 Nov.
Background Rheumatoid arthritis (RA) is a systemic autoimmune disease with multiple known comorbidities and risk factors. The rate and severity of different comorbidities among RA patients are influenced by various demographic, behavioral, and socioeconomic factors, which can vary widely between urban and rural areas. However, limited information is currently available regarding the association of comorbidities with RA in rural settings. In this study, we investigated the prevalence of common comorbidities and risk factors of RA among RA patients from a rural hospital located in rural northern New York and compared them against national patient records obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Methodology We compared de-identified patient records of 153 RA patients obtained from St. Lawrence Health (SLH) to 198 RA patients from the NHAMCS. After performing the descriptive analyses and removing outliers, two-sample tests of proportions were used for comparing the binary categories of sex, age, obesity, hypertension, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) between the two datasets. These analyses were applied to both weighted and unweighted sets of national data, and a p-value of <0.05 was considered statistically significant. The differences were then explored at a greater resolution by binning body mass index, blood pressure (BP), COPD prevalence, and tobacco usage data across different age groups. Results A significantly higher rate of diastolic hypertension (χ = 17.942, w = 0.232, p < 0.001) and over two times higher prevalence of COPD (χ = 7.635, w = 0.147, p = 0.006) were observed among RA patients in the rural group. The rates of CHF were significantly different only when sample weighting was applied. When categorized by age groups, diastolic BP showed a peak at 40-49 years, coinciding with the age group for high tobacco smoking and peak disease activity in rural RA patients. Conclusions A higher prevalence of comorbidities of RA such as hypertension (diastolic) and COPD are observed in patients from northern rural New York compared to the national average. Our findings indicate that rural RA patients might have a distinct comorbidity burden, suggesting the need for larger-scale studies.
类风湿性关节炎（RA）是一种具有多种已知合并症和风险因素的全身性自身免疫性疾病。RA患者中不同合并症的发生率和严重程度受各种人口统计学、行为和社会经济因素的影响，城乡之间可能存在很大差异。然而，目前关于农村地区RA合并症关联的信息有限。在本研究中，我们调查了纽约州北部农村一家医院的RA患者中常见合并症和风险因素的患病率，并将其与从国家医院门诊医疗调查（NHAMCS）获得的全国患者记录进行比较。
我们将从圣劳伦斯健康中心（SLH）获得的153例RA患者的去识别化患者记录与NHAMCS的198例RA患者记录进行比较。在进行描述性分析并去除异常值后，使用两样本比例检验比较两个数据集之间性别、年龄、肥胖、高血压、慢性阻塞性肺疾病（COPD）和充血性心力衰竭（CHF）的二元类别。这些分析应用于全国数据的加权和未加权集，p值<0.05被认为具有统计学意义。然后通过对不同年龄组的体重指数、血压（BP）、COPD患病率和烟草使用数据进行分组，以更高的分辨率探讨差异。
农村组RA患者中观察到舒张期高血压发生率显著更高（χ = 17.942，w = 0.232，p < 0.001），COPD患病率高出两倍多（χ = 7.635，w = 0.147，p = 0.006）。仅在应用样本加权时，CHF发生率有显著差异。按年龄组分类时，舒张压在40 - 49岁达到峰值，这与农村RA患者中高吸烟率和疾病活动高峰期一致。
与全国平均水平相比，纽约州北部农村地区的患者中RA合并症如高血压（舒张期）和COPD的患病率更高。我们的研究结果表明农村RA患者可能有独特的合并症负担，这表明需要进行更大规模的研究。
