d'Elia Alexander, Baranskaya Aliaksandra, Haroon Shamil, Hammond Ben, Adderley Nicola J, Nirantharakumar Krishnarajah, Chandan Joht Singh, Falahee Marie, Raza Karim
Department of Public Health Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Rheumatology (Oxford). 2025 Mar 1;64(3):1029-1035. doi: 10.1093/rheumatology/keae157.
To assess whether prodromal symptoms of RA, as recorded in the Clinical Practice Research Datalink Aurum (CPRD) database of English primary care records, differ by ethnicity and socioeconomic status.
A cross-sectional study to determine the coding of common symptoms (≥0.1% in the sample) in the 24 months preceding RA diagnosis in CPRD Aurum, recorded between 1 January 2004 and 1 May 2022. Eligible cases were adults with a code for RA diagnosis. For each symptom, a logistic regression was performed with the symptom as dependent variable, and ethnicity and socioeconomic status as independent variables. Results were adjusted for sex, age, BMI and smoking status. White ethnicity and the highest socioeconomic quintile were comparators.
In total, 70 115 cases were eligible for inclusion, of which 66.4% were female. Twenty-one symptoms were coded in >0.1% of cases so were included in the analysis. Patients of South Asian ethnicity had higher frequency of codes for several symptoms, with the largest difference by odds ratio being muscle cramps (1.71, 99.76 % confidence interval 1.44-2.57) and shoulder pain (1.44, 1.25-1.66). Patients of Black ethnicity had higher prevalence of several codes including unintended weight loss (2.02, 1.25-3.28) and ankle pain (1.51, 1.02-2.23). Low socioeconomic status was associated with morning stiffness (1.74, 1.08-2.80) and falls (1.37, 2.03-1.82).
There are significant differences in coded symptoms between demographic groups, which must be considered in clinical practice in diverse populations and to avoid algorithmic bias in prediction tools derived from routinely collected healthcare data.
评估类风湿关节炎（RA）的前驱症状在英国初级医疗记录的临床实践研究数据链金数据（CPRD）数据库中的记录是否因种族和社会经济地位而异。
一项横断面研究，以确定在2004年1月1日至2022年5月1日期间记录在CPRD金数据中RA诊断前24个月内常见症状（样本中≥0.1%）的编码情况。符合条件的病例为有RA诊断编码的成年人。对于每种症状，以症状为因变量，种族和社会经济地位为自变量进行逻辑回归分析。结果对性别、年龄、体重指数和吸烟状况进行了调整。白人种族和最高社会经济五分位数为对照。
共有70115例符合纳入条件，其中66.4%为女性。21种症状在超过0.1%的病例中有编码，因此被纳入分析。南亚种族的患者有几种症状的编码频率较高，优势比差异最大的是肌肉痉挛（1.71，99.76%置信区间1.44 - 2.57）和肩部疼痛（1.44，1.25 - 1.66）。黑人种族的患者有几种编码的患病率较高，包括意外体重减轻（2.02，1.25 - 3.28）和踝关节疼痛（1.51，1.02 - 2.23）。低社会经济地位与晨僵（1.74，1.08 - 2.80）和跌倒（1.37，2.03 - 1.82）相关。
不同人口群体之间编码症状存在显著差异，在不同人群的临床实践中以及为避免从常规收集的医疗保健数据得出的预测工具中出现算法偏差时，必须考虑这些差异。
